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Optometry Coding & Billing Alert

Figure Out Frequency Rules for Surefire VF Claims

Published on Sun Nov 21, 2004

Key: Severity of disease decides how often you can bill 92081-92083

If you're examining a patient's visual fields more than once per year, watch out. Medicare may deny your claims if your patient's disease hasn't progressed enough.

CMS has established guidelines for how often you can perform visual fields on a patient, says Teresa Jones, CPO, patient coordinator for the Olympia Vision Clinic in Olympia, Wash. The allowed testing frequency is based on the severity of the disease process, as follows:

 

  •  Glaucoma suspect or mild damage with good control: Visual field once every 12 months. "If unique clinical circumstance prevents secure establishment of a baseline with the initial study, a second study within the first 12 months may be obtained with appropriate documentation of medical necessity," Medicare says.
     
  •  Glaucoma with moderate/advanced damage, good control: Once every 12 months.
     
  •  Glaucoma with moderate/advanced or mild damage, borderline control: Two times every 12 months.
     
  •  Uncontrolled glaucoma: Three times per 12 months. "In those unique clinical circumstances where a higher frequency of evaluation is indicated, documentation supporting medical necessity must be included with the claim," Medicare states.

    Medicare defines "good control" as "[a]chievement of an IOP at or below the target pressure without significant adverse effects. Subsequent observation confirms appropriateness of target pressure level by documenting lack of significant glaucoma progression."

    "Borderline control" is "[a]chievement of an IOP near but higher than the target pressure," Medicare states. The IOP is "judged possibly capable of inducing further significant glaucomatous damage. Typically further IOP reduction requires surgical intervention or additional marginally tolerated medications. Careful observation of disc and visual fields is required."

    "Uncontrolled glaucoma" is marked by evidence of glaucoma progression and IOP significantly above target pressure. "All acute glaucoma is by definition uncontrolled," Medicare says.

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