Optometry Coding & Billing Alert

Question: How often in a year can a patient have pachymetry done? Is this a once only in a lifetime procedure?

Washington Subscriber

Answer: CPT® code 76514’s (Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral [determination of corneal thickness]) allowed frequency depends on the diagnosis. If the optometrist performs corneal pachymetry for glaucoma, Medicare carriers cover the procedure once in a beneficiary’s life. Private payers may cover corneal pachymetry more often as medically indicated in corneal disease’s progression.

Check if carriers cover 76514 for the following indications and associated ICD-9 codes:

• to measure corneal thickness to assess corneal endothelium function

• to aid in the diagnosis of corneal thinning disorders (371.60-371.62, 371.71)

• to assess progression of corneal edema (371.20-371.24) or corneal dystrophy (371.57-371.58)

• in corneal transplant recipients to gauge transplant acceptance and to measure treatment adequacy

• in patients with compromised endothelial function (371.57-371.58) who are in need of cataract surgery to assess the risk of postoperative corneal decompensation and to determine the appropriate surgical approach.