Ophthalmology and Optometry Coding Alert

Question: The optometrist evaluated a patient’s pressures multiple times over the course of several hours on the same date of service to determine if the patient had glaucoma. Which codes should we report for these tests?

California Subscriber

Answer: If your provider performs a series of tests over the course of the day, also referred to as “diurnal curve testing” or “serial tonometry,” you can report one unit of 92100 (Serial tonometry (separate procedure) with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day (eg, diurnal curve or medical treatment of acute elevation of intraocular pressure)). Most Medicare carriers require that three tests be done over six or more hours before it can be considered serial tonometry.

Be sure that the record indicates how many tests were performed and the duration of the testing (e.g., first test was at 7 a.m., second test was at noon, third test was at 3 p.m., etc.). You can never report 92100 just because the provider performed tonometry once or twice during an eye exam.

Keep in mind that Medicare and CPT^® both consider tonometry incidental to an intermediate or comprehensive exam for a new or established patient (92002-92014) or E/M service (99202-99215). This is true even if the optometrist repeats the tonometry during the exam. The physician may not perform all of the serial tonometry tests in the same day, but even if the tests are spread over several days, you can still only report 92100 once. Additionally, Medicare considers the procedure bilateral, so only code it once whether one or both eyes are tested.