Optometry Coding & Billing Alert

Question: Our doctor saw a patient for droopy eyelids, and to determine the extent to which her droopy eyelids interfered with her vision, he performed two bilateral visual field tests on the same day (Humphrey full-field 120 point). The doctor performed the first field test normally, and the second after taping the patient's eyelids. The diagnosis is dermatochalasis (374.87). How should we code for this procedure? The patient has a commercial insurer that mirrors the Medicare guidelines.


Pennsylvania Subscriber

Answer: Most Medicare carriers want you to report just one code for visual fields, even if an optometrist needs to perform the test twice--once with lids untaped, once with lids taped--to confirm that the dermatochalasis is interfering with vision.

For those carriers, report one unit of the appropriate 92081-92083 code (Visual field examination, unilateral or bilateral, with interpretation and report-). Since the definition states -unilateral or bilateral,- report just one unit even when the optometrist examines both eyes.

Caveat: Not all Medicare carriers agree. HGSA Administrators, the Part B carrier for Pennsylvania, has published an article that says, -Bill for the -untaped- visual field using the appropriate visual field code (92081-92083). In addition, report the -taped- visual field with code 92499 [Unlisted ophthalmological service or procedure], and include on the claim the narrative description -taped visual field.- -

Some carriers may not even require two sets of fields for pre-blepharoplasty patients. Trailblazer only requires documentation of field restrictions within 15 degrees of fixation, so two fields are not necessary.

Try this: One way to reduce the amount of time spent in visual field testing is to create a custom visual field that uses lots of points superiorly and only a few spots below the line of sight.

Learn more: For more information, read -Conquer the Pre-Blepharoplasty Visual Field Coding Conundrum- in the July 2005 Optometry Coding & Billing Alert.