Optometry Coding & Billing Alert

Question: Can I separately report Schirmer's tests and E/M services?


Wisconsin Subscriber


Answer: Medicare and many other carriers consider Schirmer's tests to be included in the E/M service rendered, so you shouldn't separately report the test. There isn't even a specific code to use to report the service.
 
One option: You can try using 92499 (Unlisted ophthalmological service or procedure) for non-Medicare insurers, but many of them will not reimburse for the service.

Caution: You might be tempted to use 95060 (Ophthalmic mucous membrane tests). But you should use this test code, listed in CPT's allergy testing section, for mucous membrane testing, and you should not apply it for Schirmer's tear testing

Bad news: There's also no HCPCS code for the Schirmer's test materials. You can try 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]).

But you-ll need to document the price of the supplies by sending in the invoice, and the supplies- cost may not be worth the time and cost of sending this documentation to the payer.