Ophthalmology and Optometry Coding Alert

Question: Our ophthalmologist performed a Horner's Syndrome eye test, using 10 percent cocaine eye drops followed by a slit lamp exam, then possibly another drug instilled followed by an eye exam. How should I code this?


Montana Subscriber


Answer: For Medicare, your only option is 92499 (Unlisted ophthalmological service or procedure). Remember to list the name of the test in the comments area or box 19 of the claim form and attach documentation of the test.
 
For non-Medicare payers, you can report 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) and bill for the cost of the drops used.

The slit lamp examination would be included in either an E/M office visit code or an eye exam code (92002-92014).

If the ophthalmologist spends a lot of face-to-face time with the patient waiting for the reaction to the eye drops, you may be able to report the prolonged services codes (+99354-99355, Prolonged physician service in the office or other outpatient setting requiring direct patient contact beyond the usual service ...) along with the office visit or eye exam code.

But remember that if you use these codes, the time reported must be face-to-face - if the ophthalmologist just administers the drops and returns later, it doesn't count.