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Ophthalmology and Optometry Coding Alert

Reader Question:

Choose Best-Fit Low-Vision Testing Code

Published on Tue Jul 01, 2003

Question: Which code should we use for the low- vision testing that our technician performs? The testing sometimes involves up to one and a half hours of trying to get the patient to see a little better using different prescription glasses and magnifiers. The technician compared it to an eye rehab and said that he also counsels on daily living activities.
     
Wisconsin Subscriber


Answer: Your question involves two different processes: The first is the low-vision testing, and the second is the counseling.
 
Let's discuss the low-vision testing first. At this time, Medicare will not pay for this service unless it constitutes part of occupational therapy and is administered by a licensed occupational or physical therapist who is trained in low-vision care. (Legislation is pending that could change this situation; see article 4, the news brief "Bill Medicare for Low-Vision Testing?".)
 
Effective May 29, 2000, Medicare began covering rehabilitation services for beneficiaries with vision impairment. Part of the memorandum states, "A Medicare beneficiary with vision loss may be eligible for rehabilitation services designed to improve functioning, by therapy, to improve performance of activities of daily living, including self-care and home management skills."
 
The memorandum also states that the Medicare physician must provide a written treatment plan. Therapeutic services can include mobility, daily living activities and other rehabilitation goals "that are medically necessary." The patient must have restoration potential and have a reasonable expectation of improvement. You can read this memorandum at http://cms.hhs.gov/manuals/pm_trans/AB02078.pdf.
 
For coding counseling for daily living activities, Medicare will accept 97535 (Self-care/home management training [e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment] direct one-on-one contact by provider, each 15 minutes).
 
Additional codes you can use for billing the counseling include:

  •  97532 Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact by the provider, each 15 minutes

  •  97533 Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by the provider, each 15 minutes

  •  97537 Community/work reintegration training [e.g., shopping, transportation, money management, avocational activities and/or work environment/ modification analysis, work task analysis], direct one-on-one contact by provider, each 15 minutes

    • This is not a complete list; please refer to the program memorandum and to your local medical review policies for specific coverage details.
     
    Note: See these past issues of Ophthalmology Coding Alert for two articles that provide additional information about low-vision coverage: "CMS Sees to Establishing Low-Vision National Coverage" in the August 2002 issue and "Please Payers with Low-Vision Therapy Coding" in the December 2002 issue.

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