Ophthalmology and Optometry Coding Alert

Question: A private carrier keeps denying our claims for corneal topography. I report 92499 and put an explanation in the comments area, but the carrier denies the code because it's for an unlisted procedure. How should I report the topography?


Maine Subscriber

Answer: There is no specific CPT code for corneal topography. For non-Medicare payers, you may try using HCPCS code S0820 (Computerized corneal topography, unilateral) for this procedure. Just keep in mind that all payers are not required to recognize HCPCS codes, and there is a plan eventually to phase out these codes. Make sure you use the appropriate ICD-9 codes, such as 371.00-371.04 (Corneal scars and opacities) or 372.40-372.45 (Pterygium), to get paid when billing topography.

To report the procedure to Medicare carriers, use 92499 (Unlisted ophthalmological service or procedure). Make sure you have "corneal topography" typed into the comments area or Box 19 on your claim form and send a description with the claim.

Frequently, a payer will deny a claim submitted with unlisted-procedure codes due to lack of information in processing the claim. The payer may not clearly request this additional information in its denial, but an appeal is in order.

Be sure to provide clear, concise, documented information describing the procedure performed, the reasons why it was performed, and any other information to support medical necessity.
 
Attach this information to the claim and request a manual review of the claim and the attached documentation.