Ophthalmology and Optometry Coding Alert

Question: Our ophthalmologist saw a glaucoma patient and performed a gonioscopy. The ophthalmologist also took slit lamp photographs to document an iris nevus during the same session. Can we report the procedures separately?

Kentucky Subscriber

Answer: Normally, you cannot report a gonioscopy and slit lamp photographs together because Correct Coding Initiative (CCI) edits forbid it. On the other hand, you can report the two services separately using modifier 59 (Distinct procedural service) and separate diagnosis codes in certain circumstances.

Because the ophthalmologist performed the gonioscopy and the slit lamp photos for different reasons, you can report both procedures but medical necessity must be documented to indicate why both services were necessary on the same site during the same encounter:

Link the appropriate iris nevus diagnosis code (224.8, Benign neoplasm of eye; other specified parts of eye) to 92285 (External ocular photography with interpretation and report for documentation of medical progress [e.g., close-up photography, slit lamp photography, goniophotography, stereo-photography]) for the photos.

Attach modifier 59 and the appropriate glaucoma diagnosis code (365.x) to 92020 (Gonioscopy [separate procedure]) to represent the gonioscopy. You should also document the physician’s findings and the condition’s status in the interpretation and report for the test.

Why? The modifier tells the insurance carrier that the iris nevus and gonioscopy were separate procedures, not components of one another. Because 92020 appears in column 2 of the CCI edits, append the modifier to that code and not 92285, which is the column 1 code.