Ophthalmology and Optometry Coding Alert

When the scanning laser (CPT 92135, scanning computerized ophthalmic diagnostic imaging [e.g., scanning laser] with interpretation and report, unilateral) was created in 1999, few ophthalmologists had access to one, and those that did, didnt know how to bill because there wasnt a code. Now, however, many ophthalmology offices have the machine and are billing the new code. But, once you have the machine (which costs from $30,000 to $60,000) in your office, you need to know how to bill the code (which pays about $70 per eye) properly to receive appropriate reimbursement.

Unilateral Code

If you perform scanning laser tests in both eyes, you must bill the code twice. The code is unilateral, says Jon Winders, clinic coordinator for Umpqua Valley Eye Associates, a four-ophthalmologist practice in Roseburg, Ore. We usually perform it in both eyes, Winders says. We bill it on two lines. His claim for the scanning laser is:

92135-LT
92135-RT

Technically, you could use the -50 modifier (bilateral procedure) on 92135 and file a one-line claim. Check with the payer to see if there is a preference.

Your carrier may have some odd rules about this code. Georgia Medicare splits 92135 into a technical component (-TC) and professional component (-26) and requires the use of a local modifier (-ZD) to denote that you performed both components. In fact, 92135 comprises both the professional and technical components, and in the highly unlikely case that you split them, -TC and -26 suffice.

Under the Georgia policy, all claims would show the -ZD modifier for 92135 unless one practice does the technical component only and another practice does the professional component only on the same patient. If an ophthalmologist has this equipment in his or her office, the physician would never perform just the technical or professional component, explains Lise Roberts, vice president of Health Care Compliance Strategies, an interactive compliance training consultancy based in Jericho, N.Y.

In Georgia, you have to code this procedure on two lines with the local modifier to show you performed both technical and professional elements in each eye:

92135-ZD-LT
92135-ZD-RT

The LMRPs regarding 92135 include most of the glaucoma diagnosis codes (365.xx) to be used for the scanning laser. Some also allow retinal nerve fiber bundle defects (362.85), scotomas (368.4x), papilledema (377.xx) and other conditions.

Follow Frequency Guidelines

Some individual carriers have limits on the number of times you can perform this test. The scanning laser is best used in glaucoma in its early stages, when early problems can be discovered and treated without unnecessary medical or surgical intervention. Therefore, many carriers will pay for visual field testing (92081-92083), but not for the scanning laser in advanced stages of glaucoma.

Empire Medicare in New York state allows one follow-up claim of 92135 per year with patients with pre-glaucoma or mild damage. The carrier allows one or two tests in patients with moderate damage. However, if visual field testing is done as well, the carrier only allows one of each. The carrier does not cover the scanning laser for patients with advanced damage. Finally, it does not pay for the scanning laser for validating a diagnosis that has already been confirmed by other diagnostic procedures.

For all three glaucoma tests visual fields, fundus photography and the scanning laser you need to get a baseline first. This means that, technically at least, you could perform and bill 92135 on all your glaucoma patients for a baseline. During the first months after Winders group purchased the machine, the practice filed many 92135 claims for baselines. We have hundreds and hundreds of glaucoma patients, he says.

Avoid Churning

For glaucoma subspecialists, there might be a great temptation to churn repeatedly perform the scanning laser procedure on all patients. If you buy one of the more expensive scanning lasers, Winders estimates that you would have to perform 600 bilateral procedures to pay for it. Virtually every patient who goes to a glaucoma specialist will have a diagnosis that supports using the optic nerve analyzer, Winders notes. But scanning every patient with an appropriate diagnosis to get paid for it is unethical. Not only that, but in a Medicare audit you could be exposed to charges of billing a service that is not reasonable and necessary for a patient. If this were found repeatedly for several patients, prosecution under the False Claims Act could be an unpleasant result.

About Laser Scanning Scanning laser glaucoma diagnostic imaging includes two types of testing that have different techniques but the same objective and are both included in 92135 (scanning computerized ophthalmic diagnostic imaging [e.g., scanning laser] with interpretation and report, unilateral): (1) Confocal laser scanning ophthalmoscopy (topography), which uses simultaneous stereoscopic videographic digitized images to make quantitative topographic measurements of the optic nerve head and surrounding retina. (2) Scanning laser polarimetry, which measures change in the linear polarization of light. Along with the scanning laser, the polarimeter measures the thickness of the nerve fiber layer of the retina.