Pediatric Coding Alert
CPT Code 99230 Is Not Used for Fluorescein Strip
That appears to be what happened to Cathy Fata, office manager for Riverdale Pediatrics, a three-pediatrician practice in Riverdale, NY. She had been using the wrong code, but getting paid for it. Then, the payments stopped. The carrier, she says, informed her that 92230 is no longer the CPT code for the fluorescein strip and is not being paid. Whats happening?
Actually, CPT 92230 was never a code for the fluorescein strip, a simple test which is done frequently in pediatrics when, for example, corneal abrasions are suspected. The orange strip is simply dipped in the corner of the eye, which is then examined by ophthalmoscope. After applying the fluorescein, which can also be applied by drops, the eye is illuminated by a Woods lamp, which causes the fluorescein to glow rather like a black light. The fluorescein accumulates around corneal abrasions causing them to be easily visible.
There is no code for using a fluorescein strip, explains Mary Bowles, office manager for O.B. Jackson, Jr., MD, a pediatric ophthalmologist in Austin, TX. Ive never heard of any ophthalmologist using a code for a fluorescein strip, she says. We just use the E/M code.
Then what is 92230 for? A test using an ophthalmoscope and fluorescein dye, yes. But in 92230, the dye is injected into the arm. The purpose of the test is to examine the retinal blood vessels.
Its (92230) been on our superbill for 10 years, emphasizes Fata. One company had been paying it but suddenly, quite recently, stopped. The proper code to use is an office-visit code. The fluorescein strip is considered a type of diagnostic test when choosing the level of E/M service.
Now theyll probably ask for their money back, says Fata, only half-joking. It is possible that the company, having realized its mistake, will try to deduct from future payments to recoup their loss. This is an excellent example of the concept that just because the insurance plan is paying you, that doesnt necessarily mean the coding is correct. And if it isnt correct, it may come back to haunt you.
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