Ophthalmology and Optometry Coding Alert

Question: We perform taped and untaped fields for patients prior to blepharoplasty. We currently bill 92082 twice with the 76 modifier on the second line item. The fields are linked to either a blepharitis diagnosis or ptosis, depending on the situation. But much of the time, the second line item is denied. What’s the problem here?

Wisconsin Subscriber

Answer: Unfortunately, the medically unlikely edits (MUEs) for code 92082 (Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (eg, at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33)) stop at one.

This means most payers won’t reimburse you for multiple units of the code, with or without a modifier appended. “Taped and untaped visual field testing is considered one unit of service for MUE purposes,” says Part B payer WPSIC in its “Billing and Coding Guidelines for Visual Fields” document.

That situation doesn’t change if you perform visual field testing on both eyes. Medicare’s fee schedule assigns a bilateral indicator of “2” to code 92082. This means that Medicare payers will view the code as inherently bilateral, and thus will not reimburse you more for the same procedure performed a second time. CMS bases the relative value units (RVUs) assigned to 92081-92083 on the assumption that the ophthalmologist performs the work in both eyes.