Question: We received a denial from a commercial payer on CPT code 92020 Gonioscopy. It was submitted along with CPT code 92012 -25 and CPT code 66761 LPI.  Were they correct in their denial or should we appeal?

Answer: There are several points to consider in answering this question.

• The CPT description for gonioscopy includes the language separate procedure. Commercial plans may consider it a stand-alone code, not payable at the same time as an exam or surgical procedure.
• Not all commercial insurances switched from a 90-day global period to a 10-day global period for an LPI. Therefore, the modifier appended to the exam would be modifier -57 Office visit to determine the need for a (major) surgery.
• If indeed the global period of the LPI is 10 days, then, in order to bill with modifier –25, you need to make sure the established patient exam wasn’t performed solely to confirm the need for the LPI. If it was performed solely for that purpose, the exam would not be separately billable.

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