Ophthalmology and Optometry Coding Alert

Question: We are still getting denials on gonioscopy (92020) when done the same day as an eye exam. These are denials on new claims.

We havent even filed the old ones yet, and we did
a lot of work getting the old claims together. Now corporate compliance is worried. What should we do?

Anonymous Wisconsin Subscriber

Answer: Your Medicare carrier must follow the Health Care Financing Administrations (HCFA) directive issued in June, which unbundles the eye exam codes (92002, 92012, 92004 and 92014) from three tests: serial tonometry (92100), gonioscopy (92020), and sensorimotor examination (92060).

Unfortunately, it takes some Medicare carriers longer than others to implement new policies handed down to them from HCFA. Corporate compliance should not be worried if they have reviewed the most recent version of the Correct Coding Initiative (CCI), which does not bundle these services.

The unbundling was made retroactive to dates of service Jan. 1, 1998, and after, when those bundles were initiated in the first place. This is national policy, and not a matter of carrier discretion. You can get a copy of the Medicare bulletin from the regional HCFA office for your carrier jurisdiction. This can be looked up at the HCFA Web site, www.hcfa.gov.

Note: Occasionally carriers had a policy of bundling services that predates the first version of the CCI. In these cases they can petition HCFA for an exception and, if the petition is granted, they can continue the bundling. If they cant produce documentation of an HCFA-extended exception, then they have to comply with the CCI. You should report their non-compliance to the HCFA regional office for your geographical area.