Ophthalmology and Optometry Coding Alert

Question: Is there a diagnosis code that Medicare is looking for specifically for reimbursement of corneal topography? They used to pay with a V-code only. Now it seems they will reject V-codes one time and pay another. We only bill this for patients that have either had PK, or are going to have PK.

Bay Eye Associates, Traverse City, Mich.

Answer: Most Medicare carriers will not pay for corneal topography, which is an unlisted code (92499) to begin with, unless the service is performed for surgically induced astigmatism. There is no specific diagnosis code for surgically induced astigmatism; to indicate this you use 367.21 for regular astigmatism or 367.22 for irregular astigmatism, followed by V45.6 for condition following surgery, or V42.5 for corneal transplant. Each carrier has different rules for how to file for unlisted procedure codes.

But in most cases you will not be able to file these claims electronically. You usually must file them hard copy because you need to attach a copy of the findings of the corneal topography. On the HCFA 1500 form, write corneal topography and see attached in box 19, and attach a letter and the documentation of the findings. If it gets rejected the first time, dont give up. You may need to call and explain why the corneal topography was done.

This is an example of why its important to develop a rapport with the insurance carriers, including Medicare. Get to know the people in your specialty. Some Medicare carriers have established a local medical review policy (LMRP) that explains how to file the claim and what diagnoses are acceptable for coverage. If there is someone familiar with ophthalmology who is at the plan, you will fare much better.

Tip: It is probably futile to try to get paid for this procedure for astigmatism that is not surgically induced, for unexplained visual loss, or for any other condition.