These coding tips will help you achieve documentation compliance, which will result in proper payment of claims the first time:
Payment for Special Testing Services
- Identify the top five payers to your practice and become familiar with their payment policies and fee schedules. Can tests such as visual fields, fluorescein angiography, etc., be billed the same day as an exam? Can a minor surgical procedure be performed (and paid!) the same day as an exam? Does the payer recognize all modifiers listed in the modifier section of CPT? What are the postoperative periods for the major and minor surgical procedures you perform most often?
- Find out which ophthalmic tests have unilateral payment and which have bilateral payment.
- Create Excel cheat sheets that list the fee schedules for E&M and eye codes for each of your top five payers. Establish when it is appropriate to code a 92XXX exam versus a 99XXX for each payer.
- Be aware that documentation requirements for eye codes may vary by state and by payer. This is particularly important if you have satellite offices in a neighboring state.
- Keep in mind that ophthalmologists are more likely to be audited on their examinations over audits on tests or surgical procedures.
Payments for special testing services are either payable per session (inherently bilateral) or per eye (unilateral payment).
- 92020 Gonioscopy
- 92025 Topography
- 92060 Sensorimotor exam
- 92081/82/83 Visual fields
- 92100 Serial tonometry
- 92250 Fundus photography
- 92285 External photography
- 92286 Endothelial microscopy/cell count
New for 2011
- 92225/26 Extended/subsequent ophthalmoscopy
- 92235 Fluorescein angiography
- 92240 ICG
With the elimination of CPT code 92135 Scanning computerized ophthalmic diagnostic imaging, posterior segment, (eg, scanning laser) with interpretation and report, unilateral,
the three new codes taking its place are inherently bilateral.
- 92132 Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral
- 92133 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve
- 92134 Retina
: When performing an inherently bilateral test on only one eye, it is not necessary to append modifier -52 (reduced services) or the specific eye modifier (-RT or -LT).
: Unless specifically stated in CPT, this may vary for commercial or non-Medicare payers.
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About the author: This article is a compilation of articles from the June, August, and November 2010 issues of Coding Bulletin. They were all originally written by Academy Coding Executive Sue Vicchrilli, COT, OCS.