Ophthalmology and Optometry Coding Alert

Question: I was happy to see a response to my question regarding forced ductions (see July 1999 Ophthalmology Coding Alert, page 55). However, we do not always do these under anesthesia. What is the code for forced ductions without anesthesia?

Lynn C. Day, Practice Manager
Pediatric Ophthalmology Specialists
St. Petersburg, FL

Answer: Duction is the movement ability of one eye as measured independently from the other eye. It is almost always done under general anesthesia; the exception is pediatrics. The code for forced ductions is 92018 (ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; complete). Clearly, it includes general anesthesia. But without general anesthesia, the best route is to bill 92018 with a -52 modifier, indicating reduced services. Because you are not doing the general anesthesia, there is less risk. There is no code for doing this procedure without anesthesia, and if a code says something is done with anesthesia, it must be done with anesthesiaunless you use the -52 modifier.