Ophthalmology and Optometry Coding Alert

Question: Our California-based workers' compensation claims for gonioscopy are being denied as included in the E/M charge. How can I convey in my appeal to the carrier that the gonioscopy is truly a separate procedure?

California Subscriber

Answer: While it may be perfectly clear to you and your practice that the gonioscopy is a separate procedure that should be separately billable, conveying that message to your carrier may not be easy.

Your best bet is to present the fact that gonioscopy, 92020, is not considered a component of another comprehensive procedure according to the latest Correct Coding Initiative edits, nor do Medicare carriers deny 92020 when it is billed as a service separate from an evaluation and management code.

If you are unable to sway your carrier on the issue, try appending modifier -59 (Distinct procedural service) to the gonioscopy code if it is done, for example, as a separate procedure from an argon laser trabeculoplasty, 65855 (Trabeculoplasty by laser surgery, one or more sessions [defined treatment series]).