Optometry Coding & Billing Alert

Question: Our practice has recently purchased a GDx. We are going to offer the use of this technology to other local practitioners by having them send their patients over for testing. Can we bill both a 99201 and 92135-TC for this encounter if a technician completes the GDx exam at our office?


Massachusetts Subscriber


Answer: Unless you actually provide the service and address the patient's chief complaint, you should not report 99201 (Office or other outpatient visit for the evaluation and management of a new patient-). Stick with reporting 92135 (Scanning computerized ophthalmic diagnostic imaging [e.g., scanning laser] with interpretation and report). Append modifier TC (Technical component) to show the insurer that your office is only performing the technical work, but not the professional component (the interpretation and report).

If the patient requests additional care while he is in your office receiving the GDx scan, you may be able to report 99201. In those cases, however, it's probably safer to have the patient consult the referring doctor first--which will keep the referring doctor happier, too.