Ophthalmology and Optometry Coding Alert

There may only be one gonioscopy code, but there are several ways you can sabotage your 92020 claim.

Most ophthalmology coders may already know that there’s only one answer to the question “How do you code gonioscopy?” Code 92020 (Gonioscopy [separate procedure]) is the only gonioscopy code in the current CPT^® manual. However, coding the procedure isn’t always straightforward, as the below frequently-asked questions and answers demonstrate.

Question 1: Is 92020 Inherently Bilateral?

Most insurance companies, including Medicare, consider 92020 a bilateral procedure code. This means that you cannot report the code twice when your ophthalmologist performs a gonioscopy on each eye.

“Billing the service automatically implies that while you performed the service or test on both eyes, you are only allowed to bill one unit,” explains David Gibson, OD, FAAO, a practicing optometrist in Lubbock, Texas.

Although CPT^® doesn’t specifically describe the procedure as bilateral in the code descriptor, most insurers follow Medicare’s lead. You can find the bilateral surgery indicators in the fee schedule. Check the column of the database marked “Bilat Surg.” The fee schedule assigns 92020 a bilateral surgery indicator of “2,” which means that Medicare has set the relative value units (RVUs) for gonioscopy based on the ophthalmologist performing the procedure bilaterally.

Tip: If the ophthalmologist performs the gonioscopy on just one eye, your carrier may require you to indicate that the physician did not perform the full bilateral procedure. To do so, append modifier 52 (Reduced services) to 92020.

Question 2: Which Diagnoses Will Prove Medical Necessity?

The diagnoses that support medical necessity for the gonioscopies your ophthalmologist performs depend on your carrier’s local coverage determinations (LCDs). Each payer you bill may have different policies regarding 92020 reimbursement. In many cases, you can search for local coverage decisions (LCDs) on the insurer’s website.

Remember: To support medical necessity for the test, merely linking an appropriate diagnosis code to 92020 isn’t enough. Your ophthalmologist must document the diagnosis or clinical signs and symptoms in the patient’s medical record.

Example: A patient is in for a routine exam and has no complaints. The ophthalmologist finds intraocular pressures of 30 mm Hg in both eyes along with suspicious cupping. He performs gonioscopy and visual fields but does not find glaucoma.

Report 9208x (Visual field examination, unilateral or bilateral, with interpretation and report ...) and 92020 linked to ICD-9 code 365.01 (Borderline glaucoma [glaucoma suspect]; open angle with borderline findings, low risk).

Other diagnoses that many insurers accept to prove medical necessity for gonioscopy include:

• 190.0-191.9 — Malignant neoplasm of eye or brain
• 198.3 — Secondary malignant neoplasm of brain and spinal cord
• 224.0 — Benign neoplasm of eyeball, except conjunctiva, cornea, retina and choroid
• 225.1 — Benign neoplasm of cranial nerves
• 362.31 — Central retinal artery occlusion
• 362.35 — Central retinal vein occlusion
• 364.00-364.9 — Disorders of iris and ciliary body
• 365.00-365.9 — Glaucoma
•  379.32-379.34 — Aphakia and other disorders of lens
• 921.3 — Contusion of eyeball
• 996.51 — Mechanical complication of prosthetic corneal graft
• 996.53 — Mechanical complication of ocular lens prosthesis
• 996.69 — Infection and inflammatory reaction due to other internal prosthetic device, implant and graft.

Question 3: Can I Code an E/M Visit With 92020?

The Correct Coding Initiative (CCI) does not bundle 92020 with new patient (99201-99205) or established patient (99212-99215) office visit codes. CCI, however, bundles 99211 with the gonioscopy code, so you cannot report a level-one visit with the gonioscopy test. A modifier indicator of “1” indicates you’re allowed to report both services under the appropriate circumstances.

CCI also allows you to report 92020 with both new and established patient ophthalmological service codes (92002-92014, Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program …). At one time, CCI bundled 92020 with these codes, but CCI deleted those bundles in 1998.

Important: CCI indicates that you cannot report special ophthalmological services codes 92018 (Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; complete) and 92019 (… limited) with 92020.