Ophthalmology and Optometry Coding Alert

Question: Our ophthalmologist saw a glaucoma patient and performed a gonioscopy. The ophthalmologist also took slit lamp photographs to document a nervous iris on her during the same session. Can we report the procedures separately? Kentucky Subscriber Answer: Normally, you cannot report a gonioscopy and slit lamp photographs because the National Correct Coding Initiative (NCCI) forbids it. However, you can report the two services separately using modifier -59 (Distinct procedural service) and separate diagnosis codes in certain circumstances.

Since the gonioscopy and the slit lamp photos were performed for different reasons, you can report both procedures.

You should:

link the appropriate iris nevus diagnosis code to 92285 (External ocular photography with interpretation and report for documentation of medical progress [e.g., close-up photography, slit lamp photography, goniophotography, stereo-photography]) for the slit lamp photos.
attach modifier -59 and the appropriate glaucoma diagnosis code to 92020 (Gonioscopy [separate procedure]) to represent the gonioscopy. You should also document the physician's findings and the status of the condition in the operative report. Why? The modifier tells the insurance carrier that the nervous iris and gonioscopy were separate procedures, not components of one another. Remember: Append modifier -59 to the code with the lower relative value units (RVUs), or your office might miss out on legitimate reimbursement. -- Reader Question and You be the Expert were reviewed by Catherine Brink, CMM, CPC, president of Healthcare Resource Management in Spring Lake, N.J.