Optometry Coding & Billing Alert

Avert confusion over new 2004 codes with this update

CPT 2004 has replaced Category III code 0025T with new code 76514. Not only has the code for pachymetry changed but the description of the service has, too.
 
Previously, CPT's descriptor for 0025T included the language "with interpretation and report," which indicated that physicians needed to document the service's professional portion - the interpretation. In contrast, CPT 2004 does not require that physicians document interpretation to report 76514 (Ophthalmic ultrasound, echography, diagnostic; corneal pachymetry, unilateral or bilateral [determination of corneal thickness]).
 
But watch out: You'll still need to document the interpretation to get reimbursed for 76514. That's because the Medicare fee schedule values the service with a -TC (Technical component) and -26 (Professional component), which means to accurately bill for the entire service, the optometrist must document other components. Since this is a new code, consult your local carriers to be sure of what they require.
 
The AMA's decision to convert 0025T from a Category III code to a procedure code reflects the procedure's usefulness and popularity.

Fight for Your Right to Pachymetry

Now, most carriers will not reimburse for pachymetry if the patient has a previous glaucoma diagnosis. Physicians in many areas continue to challenge this exclusion - and some have successfully convinced their carriers to cover pachymetry for glaucoma patients.
 
"It's essential to one portion of the eye exam," says Christine Fitzgerald, CPC, office manager at the Rhode Island Eye Institute.
 
"We basically have been doing these things for free because our carrier in Rhode Island doesn't cover it. We're hoping that with the new categorization of the code that it's going to be a covered benefit," she says.
 
"Neighboring Massachusetts Medicare is paying for it under the 0025T," Fitzgerald says, "so we tried to use that ammunition with our Rhode Island carrier."
 
When Fitzgerald's office first bought the pachymetry machine, they appealed everything. "But we're talking about a $20 test, and we were spending $50 in administrative work to appeal it. We pretty much gave up on it. We're hoping now with the new 76514 we'll have a little better luck."