• Physician Testing Services for Glaucoma

    January is Glaucoma Awareness Month. What better time to review testing services with the diagnosis of glaucoma. Rather than list them in CPT chronological order, these testing services are listed as highest to lowest volume of use by CMS 2014 data. Volume tends to trigger audits, so make sure your documentation, which is payer specific, meets the mark for each test performed.

    For example: Gonioscopy CPT code 92020 was submitted 873,923 times in 2014; Serial tonometry CPT code 92100 was submitted for payment 39,904 times.

    Glaucoma Testing Services That Can Be Delegated

    For any test that is delegated, documentation must include:

    • A written order delegating the test. The order must be in the medical record, not on the superbill or route slip. If the order is documented in a previous visit, be sure to include the order in an audit situation.
    • The specific test
    • Which eye(s) to be tested
    • The medical record should reflect medical necessity
    • The physician interpretation and report.

    Most Used Testing Services for Glaucoma in 2014

    1. Fundus photography

    Fundus photography CPT code 92250 which was billed 2,863,724 times, which has the highest volume billed. Of course the number is high as it is frequently submitted by retina specialists too.

    Payment: Inherently bilateral. Bill the code once whether photographing one eye or both.

    Frequency: Payer specific. For example the LCD from First Coast states, “Preglaucoma, borderline glaucoma, and glaucoma are generally slow disease processes which can be followed by modalities other than fundus photography. Baseline studies will, however, be allowed when performed by the treating physician as part of initial glaucoma eye care. Either of two situations may apply:

    Intraocular pressures are clearly documented in the patient's medical record and are at or above 21mm Hg or there is a difference in cup/disc ratio between the two eyes of 20% or greater.

    Intraocular pressures are less then 22mm Hg and there is clear funduscopic evidence of glaucomatous optic nerve damage (e.g., abnormal cup size, thinning or notching of the disc rim, progressive change, disc hemorrhage, nerve fiber layer defects).

    In either instance, repeat studies by the same physician more than once per year would generally not be expected unless other clinical indications exist to justify the study.”

    Bundling Edits: N/A

    2. Visual Field

    Visual field CPT code 92083 was performed 2,784,332 times

    Payment: Inherently bilateral. Bill the code once whether photographing one eye or both.

    Frequency: Payer specific. For example from WPS, “Stabilization or progression of glaucoma can be monitored by a visual field examination, or by such services as scanning computerized ophthalmic diagnostic imaging. This evaluation must be performed at regular intervals to determine that the prescribed management is adequately controlling progression of disease to the degree possible. The frequency of such examinations is dependent on clinical judgment as well as the variability of intraocular pressure measurements (i.e., progressive increases despite treatment indicate a worsening condition), the appearance of new hemorrhages and progressive cupping of the optic nerve. Claims submitted for visual field examinations performed at unusually frequent intervals may be reviewed in order to verify that the services were medically reasonable and necessary.”

    Bundling Edits: N/A

    3. Scanning Computerized Ophthalmic Diagnostic Testing

    Scanning Computerized Ophthalmic Diagnostic Testing CPT code 92133 was submitted 2,320,020 times.

    Payment: Inherently bilateral. Bill the code once whether photographing one eye or both.

    Frequency: Payer specific. For example, from Novitas, “It is expected that only two exams/eye/year would be required to manage the patient who has glaucoma or is suspected of having glaucoma.”

    Bundling Edits: 92250 Fundus photography. Mutually exclusive with 92134 Retina OCT

    4. Corneal Topography

    Corneal topography CPT code 76514 was submitted 434,687 times for payment.

    Payment: Inherently bilateral. Submit once when reporting only one or both eyes.

    Frequency: Typically covered once in a lifetime per patient. For the Medicare Part B patient, best to obtain an ABN and append modifier –GA to the claim. If Medicare denies for frequency edit, the patient is responsible for payment.

    Bundling Edits: N/A.