Optometry Coding & Billing Alert

Note: You must use the appropriate glaucoma code to support all of the above procedure codes except for 99275. You could submit 99275 with either the glaucoma code or the appropriate cataract diagnosis code, Gibson says.

Case #3: A 67-year-old established patient presents for an exam complaining of mild itching of both eyes that appears to be seasonal. Previous exams have been within normal limits, but today the optometrist notes an early nasal step on the Humphrey FDT in the right eye.

Procedures: The patient receives a comprehensive eye exam, a provocative glaucoma test with IOP before and after dilation, an extended threshold fields exam, and extended ophthalmoscopy.

Diagnosis: The optometrist documents chronic conjunctivitis and borderline glaucoma with an open angle.

Correct Coding: You should link diagnosis code 372.10 (Chronic conjunctivitis, unspecified) to 92014 (Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits) for the basic eye exam, Gibson says. Then link 365.01 (Open angle with borderline findings) for suspected glaucoma to the CPT codes for the provocative glaucoma test (92140) and the extended threshold fields test (92083), he adds.

You should also report 92225 (Ophthalmoscopy, extended, with retinal drawing [e.g., for retinal detachment, melanoma], with interpretation and report; initial) for the extended ophthalmoscopy. Code 92014 includes routine ophthalmoscopy, but you can report extended ophthalmoscopy separately, says Tami Bindas, office manager at Hazleton Eye Center in Hazleton, Pa. And make sure to note that 92225 indicates an extended ophthalmoscopy on only one eye.

If the optometrist performs the service on both eyes, bill 92225 and append modifier -50 (Bilateral procedure), says Marsha H., a biller with Sussex Eye Center in Selbyville, Del.

Case #4: A 37-year-old former patient visits your optometrist for a checkup and complains only of a very vague symptom: visual field loss that appears to come and go. The patient says that when the defect is present, it seems to be in the shape of a letter "C." The patient has no history of migraine headaches and says that headaches do not follow her visual field loss events. The patient is otherwise in good health and is unable to establish any pattern of occurrence or length of the visual events.

Procedures: The optometrist performs a comprehensive exam and decides also to do an extended threshold visual field exam.

Correct Coding: You should link diagnosis code 368.10 (Subjective visual disturbance, unspecified) to 92014 for the established patient comprehensive eye exam, Gibson says. Remember also to report 92083 for the visual field exam.

Case #5: A 76-year-old established patient presents with no complaints and says his visit is simply because it's summer and he always has an eye exam during the summer. The optometrist's additional questioning about blurred vision, asthenopia, itching, burning, eye strain and the results from previous eye exams yields no additional complaints. The exam reveals nothing significant - the patient's corrected acuities are 20/20 in right and left eyes, and IOPs are normal.

Correct Coding: This is a routine exam, so you should report S0621 (Routine ophthalmological examination including refraction; established patient) with diagnosis code 367.4 (Presbyopia), Gibson says. Why 367.4? In this case, you don't know if the patient is myopic or hyperopic, but because he is 76 years old, the optometrist knows for sure he is presbyopic, he says.

Caution: Medicare will not pay on this code because it is routine care. Since the patient doesn't present with any complaints, you should code the visit as a routine exam no matter what diagnoses the optometrist finds during the examination, Gibson says.