Ophthalmology and Optometry Coding Alert

Corneal topography has no procedure code, and most practices we spoke to dont even bother filing a claim for it. But Vicki Wadsworth, office manager and billing manager for Northern Wyoming Ophthalmology, a solo provider in Cody, WY, doesnt believe in giving up. And she has found a solution that works, every time, with her Medicare carrier, BC/BS of Wyoming.

When I got here two years ago I didnt see why we werent getting paid for corneal topography, Wadsworth tells us. I sat down and did the research, and now we do get reimbursed.

The only code she can use is 92499, which is for an unlisted ophthalmological service or procedure. But it is the documentation which gets the claim paid. I have to add an analysis and copies of the topography, she says.

Wadsworth also sends a form letter that reads as follows: On (date) I examined (name of patient) who presented with a complaint of (complaint). Corneal topography was performed on the (left or right) eye in order to obtain quantitative and qualitative information about the cornea that would assist with diagnosis. As evidenced by the attached documentation, corneal topography revealed (diagnosis). Wadsworth attaches a copy of the corneal topography findings to the letter.

The diagnosis is very important, Wadsworth adds. At this point the only thing they will accept is astigmatism, either regular (367.21) or irregular (367.22), and it must be along with either the condition following surgery (V45.6) or corneal transplant (V42.5). (The V code used most frequently by Wadsworth for this claim is V42.5). You should check with your Medicare carrier to see what requirements they have for getting reimbursed for corneal topography. But you should not assume that they wont pay it.

Finally, on Item 19 on the HCFA form, you must indicate Corneal Topography, and then write see attached, Wadsworth continues.

Should you start back-billing all of the corneal topographies you have done in the past year? You can either write it off, or you can delete the adjustment and re-bill it, says Wadsworth. Put it in as a resubmitted or corrected claim, and highlight Item 19, she recommends. I had a lot of back-billing to do when I figured this out, but I did it -- and got paid.