Ophthalmology and Optometry Coding Alert

Ophthalmology Tests:

Check This Comprehensive Guide to Report Diagnostic Tests Correctly

Published on Mon May 17, 2021

Every practice performs pre-exam tests, so ensure that you collect for yours.

When patients visit the ophthalmologist or optometrist, the visit typically involves services that go beyond E/M or ophthalmological services. In most cases, eye care physicians also perform ophthalmic testing, which can include refraction, gonioscopy, or A-scan biometry, among other tests.

The testing that your providers perform will depend on the reason the patient visited your practice, their symptoms, how long it’s been since their last visit, their personal and family history, and many more factors. Check out a few of the most common tests, along with tips on how to code these services.

Don’t Expect Medicare Pay for Refraction

CPT^® code: 92015 (Determination of refractive state).

What it is: In refraction, the examiner determines the prescription required for the eyeglasses or contact lenses by evaluating the effectiveness of a series of lenses through which the patient is asked to view a series of charts.

Coverage rules vary by payer, and because refraction is not a covered benefit under Medicare Part B, you do not need to present an Advance Beneficiary Notice (ABN) to the patient, although some practices find that this courtesy allows them to collect from the patient more easily. Some commercial payers and vision plans may cover refraction, so check each patient’s policy before they present for the visit.

Be sure to include in your documentation a note of performance and best-corrected visual acuity. Bill only one instance of the code, whether your examiner tested one or both eyes.

Corneal Topography Testing Requires Documentation of Findings

CPT^® code: 92025 (Computerized corneal topography, unilateral or bilateral, with interpretation and report).

What it is: The procedure is also known as “computer-assisted keratography” or “videokeratography.” A computer images and analyzes the shape and curvature of the patient’s cornea and displays results, often as a colored map of the corneal surface. The computer allows detection of much finer detail than other methods of examination, and has the advantage that the data can be stored for later comparison if needed.

In your documentation, be sure to note performance and findings. And check your local carrier requirements for conditions that would demonstrate medical necessity. For example, Medicare Advantage payer United Healthcare indicates in its local coverage determination (LCD), which was issued in October 2020, that corneal topography is payable “only if the results will assist in defining further treatment.”

In addition, UHC covers the condition only for very specific circumstances, such as pre-operative evaluation of irregular astigmatism for intraocular lens power determination with cataract or keratoconus diagnosis, among other issues. Therefore, it’s very important to follow your payer’s LCD to the letter if you’re reporting corneal topography.

Because the code descriptor specifies “unilateral or bilateral,” you would report this code only once whether your ophthalmologist tested one or both eyes. No modifier appendage is required either way.

Don’t miss: CPT^® code 92025 is not used for manual keratoscopy, which is part of a single-system E/M or ophthalmological service (92002-92014), according to CPT^® rules.

Remember to Report Just One Visual Field Test

CPT^® codes: 92081-92083 (Visual field examination, unilateral or bilateral, with interpretation and report…).

What it is: A VF test measures the extent of a patient’s field of vision as the eye fixates straight ahead with standard illumination. The test can help the ophthalmologist discern peripheral vision loss and blind spots, which are plotted on visual field charts.

There are three CPT^® codes for VF: 92081 (limited), 92082 (intermediate), and 92083 (extended).

Examples of indications for testing typically include glaucoma, trauma, visual pathway disorders, and optic nerve disorders. Keep in mind, however, that if your ophthalmologist wants to report two VF codes together, you are out of luck, as the NCCI edits bundle the codes together, with the note that they cannot be unbundled (reported separately) under any circumstances.

Tips: Gross VF testing is considered a component of E/M and eye code exams, not to be reported separately. Also, CPT^® codes 92081 and 92082 are bundled into blepharoplasty (CPT^® codes 15820-15823) when performed on the same day.

Ophthalmologists often perform VFs prior to blepharoplasty to determine the extent to which drooping eyelids are limiting the patient’s vision. Traditionally, many payers required two sets of visual fields: one with the patient’s eyelids untaped, and the other with the eyelids taped up, to show how much the visual fields improved. However, many payers no longer require two sets of VFs, so check your LCDs before moving forward.

Know Anterior/Posterior Distinction for SCODI

CPT^® codes: 92132-92134 (Scanning computerized ophthalmic diagnostic imaging…).

What it is: Although scanning laser ophthalmic diagnostic imaging (SCODI) is commonly used as a diagnostic test for early detection of glaucoma, it is also a valuable tool for the evaluation and treatment of individuals with retinal disease, including individuals with diabetic retinopathy and macular degeneration. SCODI is able to detail the microscopic anatomy of the retina and the vitreo-retinal interface.

For a scan of the anterior segment, report 92132 (Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral). If the provider instead scans the optic nerve in the posterior segment to test for glaucoma, report 92133 (… posterior segment, with interpretation and report, unilateral or bilateral; optic nerve). For a scan of the posterior segment to look for retinal conditions, report 92134 (… posterior segment, with interpretation and report, unilateral or bilateral; retina).

Documentation: Should include a note of performance and findings.

Don’t miss: Report only one unit of the code regardless of whether one or both eyes are tested — the phrase “unilateral or bilateral” in the descriptions of all three codes means that Medicare will reimburse only once for the procedure no matter whether you test one or both eyes.

Tip: Do not report 92133 and 92134 at the same encounter.

Know Bilateral Rules for Fluorescein Angiography

CPT^® code: 92235 (Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral).

What it is: The provider uses a special dye that causes the blood vessels in the eye to stand out in photographic images taken with the use of multiframe timing. Photography continues in 10- to 30-minute increments to check for late leakage of dye. Indications for the study typically include some macular diseases, retinal vascular diseases, inflammatory retinal or choroidal diseases, optic nerve disorders, tumors, and preparation for some forms of laser treatment.

Documentation: Typically, documentation contains a dictated report of findings.

Bilateral rules: Note that the descriptor indicates “unilateral or bilateral,” which is a change that CPT^® made in 2017. Prior to that, the code could be billed once for each eye, but that is no longer the case.

Documentation Is Key With Fundus Photography

CPT^® code: 92250 (Fundus photography with interpretation and report).

What it is: The code describes the work of taking fundus photographs (images of the posterior segment of the inner aspect of the eye to document alterations in the optic nerve head, retinal vessels and retinal epithelium). It can be used to document baseline retinal findings, and to track disease progression.

The camera is, in effect, a large ophthalmoscope that allows viewing of the retina and a light flash system for producing color photographs of the retina.

Documentation: Includes note of performance and findings.

Bilateral rules: Medicare considers 92250 to be inherently bilateral. In other words, it bases its reimbursement on the procedure being performed on both eyes. Therefore, there is no need to append modifier 50 (Bilateral procedure) to 92250 if the ophthalmologist performs it on both eyes.

Reduced services: If the ophthalmologist only photographs one eye, modifier 52 (Reduced services) may be your best bet, say experts. You can then append modifier LT (Left eye) or RT (Right eye) to specify which eye was photographed, although those modifiers are informational and do not affect reimbursement.

Use 92020 for Gonioscopy

CPT^® code: 92020 (Gonioscopy (separate procedure)).

What it is: Using a gonioscope, the practitioner looks at the front part of the eye (anterior chamber) between the cornea and the iris. After applying an anesthetic to the eye, using a special lens (goniolens) and a special microscope (slit lamp) the ophthalmologist places the goniolens on the cornea and shines a bright light into the patient’s eye and examines the angle between the iris and the cornea. The test is done as part of an examination for glaucoma to determine the type of glaucoma, if present, as either open- or closed-angle type.

Bilateral rules: 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.

Prep for Payment Reductions

Keep in mind that Medicare implemented a payment reduction when more than one test is performed at the same encounter, says Patricia Morris, MBA, COE, an ophthalmology consultant based in New York, New York. “This payment policy reduces the technical component of the second and any subsequent ophthalmic diagnostic tests by 20 percent when more than one eligible diagnostic test is performed at a patient encounter on the same day by the same physician or group,” she notes.