Optometry Coding & Billing Alert

Question: What testing and documentation do I need to bill for 92140 (Provocative tests for glaucoma, with interpretation and report, without tonography) in a glaucoma patient?

Massachusetts Subscriber

Answer: Most often, when performing 92140, optometrists measure the following:

• Predilation intraocular pressure (IOP)

• Pharmacologic agents used

• Dilated pupil size

• IOP after dilation, as long after dilation that the patient was still in the office (up to one hour).

You should also record the times of the IOP measurements. Tests can also include dark-room tests of Seidel, prone position tests, and pharmacologic mydriatic tests.

Provocative tests for glaucoma are indicated for patients who have had an initial acute attack of elevated intraocular pressure and there is suspicion of narrow angles.

Provocative tests are also indicated in specific instances when a growing cataract is suspected of narrowing the angles.

A rise in the intraocular pressure of more than 8 mm is considered positive and may indicate angle-closure glaucoma. Presence of angle closure is confirmed by gonioscopic examination.

Warning: Even though they’re not bundled by the Correct Coding Initiative, don’t try reporting 92140 along with 92100 (Serial tonometry [separate procedure] with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day [e.g., diurnal curve or medical treatment of acute elevation of intraocular pressure]). Many carriers do not consider it medically reasonable and necessary to perform both the same day. If you bill them both, the carrier will most likely reimburse you for just one.