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Savvy Coder: Coding & Reimbursement
Testing Services, Part Three: Tests Performed by Physicians
By Sue Vicchrilli, COT, OCS, Academy Coding Executive
 
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Testing services comprise a significant proportion of the day-to-day work in an ophthalmology office. Here is a quick review of tests that are typically done by physicians. (Next month, EyeNet will review seven testing services that are typically delegated to staff.)

Gonioscopy: 92020

CPT code 92020: Gonioscopy (separate procedure).

Documentation: Note of performance and finding.

Unilateral/bilateral: Bill once whether testing one or both eyes.

–26/–TC: No.*    

CCI Version 18.1: 99211. Note: It also is bundled with 65855, the code for ALT and SLT.

Supervision: Doesn’t apply.

Payment: $26.26.

Coding tips: It is billable in addition to any level of E&M or Eye code when medical necessity exists. For gonioscopy under general anesthesia, use 92018.

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Serial Tonometry: 92100

CPT code 92100: Serial tonometry (separate procedure) with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day (e.g., diurnal curve or medical treatment of acute elevation of intraocular pressure).

Documentation: Two or more measurements of IOP throughout the day.

Unilateral/bilateral: Bill once whether testing one or both eyes.

–26/–TC: No.*   

CCI Version 18.1: 99211 and the mutually exclusive G0117 and G0118.

Supervision: Doesn’t apply.

Payment: $91.

Coding tips: Some non-Medicare payers may not allow payment the same day as an exam because of the “separate procedure” wording.

This code should not be used for IOP measurement with a general ophthalmological visit.

The diagnosis code should reflect the medical necessity of performing the service.

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Global Surgery Period
If medically necessary, tests may be billed (and paid) when performed within the global period of a major or minor surgery.

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Ophthalmoscopy: 92225 and 92226

CPT code 92225: Ophthalmoscopy, extended, with retinal drawing (e.g., for retinal detachment, melanoma), with interpretation and report; initial.

CPT code 92226:                 ; subsequent.

Audit warning: 92226 is the most frequently audited test.

Documentation: For 92225, detailed, labeled drawing of pathology; for 92226, detailed, labeled drawing of change in pathology. In either case, it is not necessary for the drawing to be in color.

Unilateral/bilateral: Payable per eye. Do not bill for the eye that does not have pathology.

–26/–TC: No.*   

CCI Version 18.1: 99211.

Supervision: Doesn’t apply.

Payment: For 92225, $25.58; for 92226, $22.87.

Coding tips: These codes are not identified by “new patient” or “established patient,” but by “initial” and “subsequent” performance of the test. When following a chronic condition after the initial extended ophthalmoscopy, use the subsequent code 92226. Use 92225 for the initial extended ophthalmoscopy or a new event (diagnosis).

Routine direct and/or indirect ophthalmoscopy is included in the E&M and Eye codes and may not be reported separately.

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* The global service for some tests can be split into a professional component (–26) and a technical component (–TC). This is important when a patient from a skilled nursing facility (SNF) comes to your office: You would bill Medicare for the professional component and the SNF for the technical component. This does not apply to the four CPT codes listed above.

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