Ophthalmology and Optometry Coding Alert

If you've been confused as to whether you should report 92020 with eye codes, E/M codes, or even at all, relief is near: Medicare has cleaned up its stance on gonioscopy billing.

You should report gonioscopy with CPT code 92020 (Gonioscopy [separate procedure]) for both indirect and direct procedures. Ophthalmologists use gonioscopy to examine the visually inaccessible anterior chamber angle, the eye's drainage apparatus (the trabecular network), and its anatomic relation to the adjacent iris. During the more common indirect gonioscopy, the physician uses a mirrored goniolens and biomicroscope to examine the anterior chamber angle opposite the direction of view. The direct method of gonioscopy uses a dome-shaped contact lens to eliminate internally reflected light so the doctor can directly visualize the angle with a gonioscope.

If you've been having problems coding gonioscopy, you're not alone. The problems stem from Medicare's conflicted past regarding this procedure.

You've probably been told at some time that you can't bill 92020 separately from an eye visit code (92002-92014) or even an E/M code (99201-99215). That's because CCI bundled the testing as a component of the eye codes for a short time, according to Amanda Kunze, reimbursement specialist at the Eye & Ear Clinic in Wenatchee, Wash. However, Medicare's policy is now stable and you can bill gonioscopy separately from the exam, she says.

The latest version of the National Correct Coding Initiative (NCCI) substantiates the fact that Medicare carriers should accept 92020 when reported along with an E/M code or eye code. "We usually use the eye codes with the gonioscopy," says Brenda Arendt, Center for Total Eye Care, Westminster, Md. You should decide based on documentation and medical necessity.

If you're unable to sway your carrier on this issue, try appending modifier -59 (Distinct procedural service) to the gonioscopy code if it is done, for example, as a separate procedure from an argon laser trabeculoplasty, 65855 (Trabeculoplasty by laser surgery, one or more sessions [defined treatment series]).

If you're providing an office visit along with the gonioscopy and the trabeculoplasty, you need to append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M or eye code. You should report the visit only when it is more extensive than a normal preoperative visit.

According to Empire Medicare Services of New York's LMRP, you should not bill for gonioscopy performed by the same physician during the global period for glaucoma surgery. The only exception to this rule is when the gonioscopy is unrelated to the condition for which the surgery was performed. This would be the case when you need to perform gonioscopy during the global period but are able to assign a separate diagnosis code or indicate that it was performed under medical necessity on the other eye, Kunze says.

What about cataract surgery? The general rule is that Medicare usually excludes testing services from the global surgical package. The gonioscopy is unrelated to the cataract surgery (66830-66986) unless the viscoelastic agents used in the cataract surgery affected the trabecular meshwork.

If the surgery was a trabeculectomy (66170, 66172), billing for the gonioscopy in the postoperative period is highly questionable because of the services that are included in the global surgical package. The Medicare Carriers Manual states that Medicare includes the following in the surgical package: