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Ophthalmology and Optometry Coding Alert

Reader Question:

Gonioscopy

Published on Mon Dec 24, 2012

Question: Can diagnosis code 379.31 (aphakia) be used for CPT 92020 (gonioscopy)?

Florida Subscriber

Answer: The medical reason for performing a service should be reported when submitting the claim to the payer. So, if the reason for performing the gonioscopy is that the patient is aphakic, that diagnosis code must be submitted. Whether or not the payer will pay the claim is another matter. Medicare carriers and many other payers use edits to help process claims through an automated procedure.

This means that your carrier will have created a list of ICD-9 codes that they feel substantiate the medical necessity requirement for paying for specific services. If aphakia is on that list, then the claim system will process the claim for payment. If it is not, you will receive a denial based on the lack of medical necessity. It will [...]
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