Optometry Coding & Billing Alert
You Be the Expert:
Scanning Laser With E/M Service
Published on Mon Feb 13, 2006
Question: I recently received a denial for a scanning laser test performed with an E/M visit. The E/M was paid, but not the scanning laser. The diagnosis codes were 366.15 and 366.16. What's wrong?
Rhode Island Subscriber
Answer: ICD-9 codes 366.15 (Cortical senile cataract) and 366.16 (Nuclear sclerosis) do not prove that the scanning laser (92135, Scanning computerized ophthalmic diagnostic imaging [e.g., scanning laser] with interpretation and report, unilateral) was medically necessary.
The scanning laser is primarily a test for glaucoma. Therefore, most of the ICD-9 codes that insurers will accept are in the 365.xx (Glaucoma) family.
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