Ophthalmology and Optometry Coding Alert

Aetna U.S. Healthcare now covers low-vision programs for patients who meet the criteria of moderate or severe visual impairment that is not correctable by conventional refractive means. The carrier defines moderate impairment as best corrected visual acuity (BCVA) of less than 20/60 in the better eye, and severe impairment as BCVA less than 20/160 (including 20/200 to 20/400) or visual field diameter 20 degrees or less in the better eye. The policy, issued last fall, does not cover optical or nonoptical low-vision devices. Medicare does not cover low vision because it does not cover low-vision aids.

The Aetna policy is a welcome change for coders like Margaret Mac, CMM, CPC, a Clearwater, Fla.-based coding and billing consultant. "Nobody used to pay ophthalmologists for this," she says. Now, based on Aetna's stated policy, ophthalmologists will be paid. Low-vision services will most likely be billed under one consultation code 9924x (Office consultation for a new or established patient ). Visual fields (92081-92083, Visual field examination, unilateral or bilateral, with interpretation and report ) can be billed separately. Low vision can be caused by diabetes, glaucoma, cataracts and, most commonly, macular degeneration. When reporting the diagnosis, use 369.xx (Blindness and low vision) first and the underlying disease second, unless a payer instructs you otherwise.

Aetna expects intervention for low vision to take place as soon as the patient has difficulty with everyday tasks. The services provided, according to Aetna, include the following, most of which are included in 9924x:

1. history of onset and effect of impairment on everyday life
2. examination for BCVA, visual fields (9208x), contrast sensitivity, color perception, and glare sensitivity
3. evaluation of near vision and reading skills
4. selection and prescription of visual aids
5. instruction in use of aids and devices
6. follow-up counseling to reinforce new patterns.