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Ophthalmology and Optometry Coding Alert

Quick Quiz:

Test Yourself On New, Updated Ophthalmology Codes and Edits

Published on Thu Apr 12, 2007

3 questions help you grasp CPT 2007's changes and the latest NCCI bundles

Still trying to digest all the changes from CPT 2007 and National Correct Coding Initiative (NCCI) version 13.0? This quiz will help you determine whether you're on the right track with the new codes and bundles.

Hint: You can find all the quiz answers in one of these three past Ophthalmology Coding Alert articles: "Go With the Flow to Determine 'New' vs. 'Established' Patient Status" from the December 2006 issue, "Make the Most of the Reimbursement Opportunity in 92025" from the January/February 2007 issue, and "Latest NCCI Edits Limit How You Use New Code 67346" from the March 2007 issue.

Question 1: You code for a group practice with three different office locations. A patient sees one of your practice's ophthalmologists for an eye exam at one office. Two years later, the same patient sees another ophthalmologist in your group practice at a different office for eye pain and foreign-body removal. Should you report a new or established patient encounter for the second service?

Question 2: Your ophthalmologist performs corneal topography on a patient's left eye. Which code(s) should you report?

A. S0820

B. 92025

C. 92499

D. None of the above

Question 3: During surgery, your ophthalmologist performs an ultrasound of the patient's eye to locate a foreign body. How should you report these services?

A. 76529

B. 76998

C. 76529 and 76998

D. None of the above

Note: Check your answers below.

Quick Quiz Answers:

Answer 1: Established. In this case, the patient is established. Regardless of the fact that the encounters took place at separate locations and involved separate ophthalmologists or different problems and diagnoses, because the ophthalmologists are of the same specialty and billing under the same group number, the "three-year rule" applies.

Had the physicians been of different specialties -- or if they billed under different provider numbers (i.e., were not partners or associates) -- the second ophthalmologist may have been able to report the patient as new, as long as she hadn't seen that patient within the previous 36 months.

Answer 2: B. As of Jan. 1, you should be using CPT 2007 code 92025 (Computerized corneal topography, unilateral or bilateral, with interpretation and report) for corneal topography, also known as corneal mapping or computer-assisted video keratography (CAVK).

In the past, you had to use unlisted-procedure code 92499 (Unlisted ophthalmological service or procedure) or S0820 (Computerized corneal topography, unilateral) depending on the insurance carrier.

Remember: You don't need a modifier to indicate if the procedure is unilateral or bilateral. Before when you reported 92499 or S0820, you may have appended modifier LT (Left side) or RT (Right side) to specify which eye was tested, because the procedure is considered to be unilateral. However, the new code descriptor specifies unilateral or bilateral, so you should report the code just once, and no modifier is necessary.

Answer 3: A. You should report 76529 (Ophthalmic ultrasonic foreign body localization). NCCI 13.0 bundles several codes with 76998 (Ultrasonic guidance, intraoperative), including the code for ultrasonic location of a foreign body. Therefore, you should only report 76529 in this scenario.

Note: These edits have a modifier indicator of "1." This means you can override the edits by reporting both codes with a modifier, such as modifier 59 (Distinct procedural service), appended to the bundled code, and expect to be paid on both under the proper clinical circumstances.

Answers reviewed by Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates, Clearwater, Fla.

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