Optometry Coding & Billing Alert

You may be able to report an unlisted-procedure code for a taped visual field test

When an optometrist has to perform two sets of visual fields for a patient about to have eyelid surgery, there is no easy way to bill for both tests. This sore spot for optometrists shows no sign of getting any better -- but there are tricks to help you get the reimbursement you deserve.
 
Last month we answered several of your frequently asked questions about VFs (see -Using Diagnosis to Determine Your VF Code? Read This First- in the May 2006 Optometry Coding & Billing Alert), but this question is often the most difficult to answer. For pre-blepharoplasty patients, many carriers direct optometrists to perform a visual field test with the patient's eyelids taped out of the way (in addition to a standard VF), showing what the postoperative field of vision will be.
 
There are three levels of visual field tests, says Rita Knapp, CPC, chief compliance officer and senior billing specialist at Abrams Eyecare Associates in Indianapolis:
 
- 92081 -- Visual field examination, unilateral or bilateral, with interpretation and report; limited examination
 
- 92082 -- ... intermediate examination
 
- 92083 -- ... extended examination .
 
Drawback: Some carriers will only pay for one set of visual fields -- and some carriers state that you can only report 92081 for this service.
 
-As optometrists, we could perform either a 92081 or a 92082. Either field could be correct,- says David Gibson, OD, FAAO, a practicing optometrist in Lubbock, Texas.
 
Strategy: Your billing depends on what your carrier will allow. One Part B carrier, HGSAdministrators in Pennsylvania, directs you toward an unlisted-procedure code. -Bill for the -untaped- visual field using the appropriate visual field's code (92081-92083),- states their LCD. -In addition, report the -taped- visual field with code 92499 (Unlisted ophthalmological service or procedure), and include on the claim the narrative description -taped visual field.- -
 
Smart: Check with your local carrier to make sure this coding scenario is acceptable.
 
Pitfall: Don't expect your modifiers to get you out of this one. Some coders recommend appending modifier 76 (Repeat procedure by same physician) to the second procedure (for example, 92082 and 92082-76), but many carriers reject this method, arguing that modifier 76 should be used with surgical procedures.
 
Another option is to append modifier 59 (Distinct procedural service) to the second procedure -- but carriers are likely to reject that, too, since the two sets of visual fields are not truly distinct from each other.
 
Exception: Not all carriers require two sets of visual fields. For example, TrailBlazer's LCD states that one untaped set of visual fields -recorded to demonstrate an absolute superior defect to within 15 degrees of fixation- is sufficient.