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While choosing the right CPT code for a test is often straightforward, the services below can cause confusion. This month, EyeNet clarifies which codes you should pick.
Eight Areas to Watch
The Adeno Detector is a point-of-care device that tests the tear film for adenoviral conjunctivitis. To qualify for payment, your facility must be certified under the Clinical Laboratory Improvements Amendments regulations. You should fill out form CMS-116 and pay a fee of $150 (go to www.cms.hhs.gov/clia and select “How to Apply for a CLIA Certificate”). The appropriate CPT code is 87809 Infectious agent antigen detection by immunoassay with direct optical observation; adenovirus. You should append modifier –QW to indicate a CLIA-waived test. You should check the CMS lab fee schedule for payment amount, as there is no physician allowable in the Medicare database with or without –QW.
The Foresee PHP is best coded as 92499 Unlisted procedure or service. Be sure to obtain an Advance Beneficiary Notice of Noncoverage (ABN) from Medicare patients.
The Micro Perimeter 1 is considered a component of the exam and is not separately billable.
The Optos Optomap is image-assisted ophthalmoscopy for evaluation of ocular health. It does not meet the criteria for the CPT code for fundus photography (92250) or the codes for OCT of the posterior segment (92133 for the optic nerve; 92134 for the retina). If you rely on the Optos technique rather than dilating the patient, then you must bill a lower level Eye code or E&M exam. The Optos can be used for a noncovered screening exam, in which case the patient is responsible for payment.
The OrbScan is best coded with CPT code 92025 Computerized corneal topography, unilateral or bilateral, with interpretation and report.
The Pentacam is best coded with CPT code 92025 (see descriptor above) or 92132 Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral. Although Pentacam does not use the same technology intended for codes such as 92132 or 92025, the services provided do fit the descriptor. If your intended use of the Oculus Pentacam is that of 92132 or 92025 topography, then the service should be billed with one of those codes; and the service should be billed only once, regardless of any other services that are provided with Pentacam.
The visual evoked potential test has no separate CPT code. It is considered to be a component of the exam.
The five modifiers most frequently appended to testing services:
–50: Bilateral performance. (Only use this for tests that are payable per eye.)
–RT: Right eye.
–LT: Left eye.
–TC: When performing only the technical component of a test.
–26: When performing only the professional component of a test.
NOTE: No modifier should be appended to an exam when a test is performed on the same day.
Category III Codes
Use Category III codes for the Ocular Response Analyzer (0181T) and measuring ocular blood flow (0198T). Category III codes exist so data can be collected on emerging technologies, services, and procedures. These data are then used to determine whether new Category I codes are needed. No relative value units (RVUs) are assigned to them on a national level, and without a payer policy there is no payment coverage. You should have Medicare patients sign an ABN.
NEXT MONTH: Learn about the documentation requirements for testing services, the tests that aren’t payable separately, and the National Correct Coding Initiative.