You Be the Coder:
Endothelial Cell Photograph
Published on Tue Oct 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the
answer.
Question: My physician ordered an endothelial cell photograph for a patient during his preoperative period for cataract surgery. Can we bill separately for the photograph?
Alaska Subscriber
|
|
Answer: According to the Coverage Issues Manual (CIM 50-38), endothelial cell photography, otherwise known as specular endothelial microscopy, 92286 (Special anterior segment photography with interpretation and report; with specular endothelial microscopy and cell count), is covered only when the patient meets at least one of the following criteria:
Has slit lamp evidence of endothelial dystrophy (cornea guttata)
Has slit lamp evidence of corneal edema (unilateral or bilateral)
Is about to undergo a secondary intraocular lens implantation
Has had previous intraocular surgery and requires cataract surgery
Is about to undergo a surgical procedure associated with a higher risk to corneal endothelial, i.e., phacoemulsification or refractive surgery (CIM 35-54)
Shows evidence of posterior polymorphous dystrophy of the cornea or irido-corneal-endothelium syndrome
Is about to be fitted with extended-wear contact lenses after intraocular surgery.
Even if the patient does meet one of these requirements, if the only visual problem is cataracts, 92286 is covered as part of the presurgical comprehensive eye exam and is not separately billable or payable, according to the CIM. Consequently, it would not be separately billable. Therefore, the key to being able to bill separately is in the diagnosis coding. A diagnosis for one of the above bullet points - that is not a cataract diagnosis - would have to apply for the endothelial cell count to be reimbursed.
You should also check to see if your carrier has a local medical review policy for endo cell count. They may have a list of what diagnosis codes are payable and a guideline for the number of cells. LMRPs can be found on the Internet at www.lmrp.net or by accessing your carrier's Web site.
|
