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Ophthalmology and Optometry Coding Alert

You Be the Coder:

Dont Include Gonioscopy in E/M

Published on Sun Jun 01, 2003

Question: What components of a diagnostic glaucoma evaluation are separately billable from the E/M service? Alaska Subscriber


Answer: When a patient presents symptomatic of glaucoma, don't assume all of the diagnostic testing your ophthalmologist performs is included in the E/M code appropriate for that visit. A typical diagnostic examination for glaucoma includes measuring visual acuity, checking the intraocular pressure, gonioscopy, pupil dilation, visual field examination, and optic nerve photography (taking fundus photographs). Of these typical components of a glaucoma exam, gonioscopy, 92020 (Gonioscopy [separate procedure]); visual field examinations, 92081-92083; and fundus photography, 92250 (Fundus photography with interpretation and report) are separately billable but these services can sometimes have specific frequency limitations. Some carriers only allow visual field to be billed once every six months, but this varies from carrier to carrier. Be sure to consult your carrier's local medical review policies on the frequency of billing these diagnostic tests before assuming you should report them separately.
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