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Ophthalmology and Optometry Coding Alert

Reader Question:

Abide by 99211 Bundling

Published on Tue Jul 01, 2003

Question: Medicare recently denied our claims for two patients' brief office visits coded as 99211 with visual field testing on the same day, which we coded with 92083. We didn't have to use any modifiers, and no global period was involved. How should we have coded this?

Texas Subscriber


Answer: The rules changed as of April 1 code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal ) is now bundled into 92083 (Visual field examination, unilateral or bilateral, with interpretation and report; extended examination [e.g., Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30, or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2]).
 
Numerous other codes were also bundled at the same time. The National Correct Coding Initiative (NCCI), version 9.1, also bundled 99211 into many other ophthalmology-related codes, including visual field exam codes 92081 and 92082, tonometry, scanning laser, and many more diagnostic tests, so you should definitely check the NCCI edits whenever coding either 99211 or diagnostic tests.
 
The good news is that NCCI made an error when it published the bundles in the 9.1 version that was released on April 1. This error will be corrected in version 9.2 effective July 1. Initially, the code bundles were listed with a footnote or indicator of "0," which meant that under no circumstances could you unbundle the services when performed on the same day. That indicator will be changed to "1," which means that if you meet the requirement to unbundle, you can append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99211 and bill the office visit service in addition to the testing services.
 
When a bundle is corrected or removed, it is removed retroactively to the date it was first implemented. So, after the change is published on July 1, you can send corrected claims and request payment. The carrier is not required to locate the denied claims.
 
You typically use modifier -59 (Distinct procedural service) to identify procedures or services that are not usually reported together but may be performed under certain circumstances; for example, a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician. 

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