Ophthalmology and Optometry Coding Alert

Question: We recently had patients with severe elevated pressure. The ophthalmologist used Osmoglyn. Can we charge for administration or bill a higher-level office visit?

Illinois Subscriber

Answer: You cannot bill for Osmoglyn, which is an oral liquid medication used to reduce excessively high intraocular pressure instead of performing surgery. Occasionally, surgery is necessary even if the Osmoglyn brings the pressure down initially. The medication typically is administered in the office. The patient must consume two cups of it, and it has the unpleasant side effect of making some patients vomit.

The patient must stay in the office for repeated pressure checks to make sure the pressure is coming down. You should report the appropriate E/M code, including Osmoglyn administration in the documentation. There is no separate reimbursement for the administration of oral medication because it is related to a noncovered item (the Osmoglyn). If the ophthalmologist performs multiple intraocular pressure checks following administration, you can bill 92100 (Serial tonometry [separate procedure] with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day [e.g., diurnal curve or medical treatment of acute elevation of intraocular pressure]) in addition to the visit.

Generally, a case requiring Osmoglyn will already be at the highest E/M level if it is properly documented. An elevated pressure that is high enough to warrant Osmoglyn administration represents a serious threat of permanent visual-function loss if it is not treated in time.