Ophthalmology and Optometry Coding Alert

Sure, you can look up each individual carriers list of covered diagnosis codes for visual field examinations and pick the closest match to your physicians documentation, but what should really drive your coding is that visual fields are diagnostic tests when performed to diagnose glaucoma. When there isnt a national policy issued by the Centers for Medicare & Medicaid Services (CMS) listing covered diagnosis codes for a procedure, coders are constantly trying to figure out which diagnosis codes will be acceptable for a given procedure. Before you start researching and re-researching carriers policies, it is a good idea to stick with the basics, otherwise you could find yourself choosing a diagnosis code just because it is covered, a.k.a. committing billing fraud. Put the Diagnostic Test Basics to Work "Visual field exams are used to test the patients peripheral vision" when performing a glaucoma exam for a symptomatic patient, says Nicola DuHamel, administrator for the Bascom Palmer Eye Institute of the Palm Beaches in Florida. "They are billable approximately every six months depending on the type of insurance," and they require interpretation and report, she says. Use the standard requirements for coding diagnostic tests issued by CMS in September 2001 to guide your choice of diagnosis codes for visual field (VF) examination codes 92081 (Visual field examination, unilateral or bilateral, with interpretation and report; limited examination [e.g., tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or 7 equivalent), 92082 ( intermediate examination [e.g., at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33]) and 92083 ( extended examination [e.g., Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30, or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2). How you assign diagnosis codes for diagnostic tests really depends on whether you submit the claim for the ordered test before or after the physician has received and interpreted the test results. If the physician who ordered the test has not received the results, the patients diagnosis code should reflect the signs and symptoms the patient presented with. If  the physician has the results of the test before submitting the claim and those results are negative, you should still code the signs and symptoms that prompted the physician to order the test. However, if the same physician who orders a test receives and interprets the results as positive before the claim has been sent to the carrier, such as when a comparative or test is performed, report the diagnosis codes for the positively identified condition, for [...]