Coding tips for testing

Optometric Management,  May 2000  by McGreal, John

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Are You Undercharging?

When you test for glaucoma, are you coding properly? Are you charging for the full amount that Medicare allows?

Many O.D.s who see glaucoma patients perform visual fields and other tests, but aren't charging the Medicare allowable.

Here's a look at the glaucoma tests you might perform and tips for documenting and charging the appropriate amount Medicare allows.

* Visual fields. You'll document for one of three types of visual field tests, which are bilateral (you're reimbursed once regardless of whether you test one of the patient's eyes or both).

1. For a screening visual field test the CPT code is 92081. Reimbursement is $45.74.

2. For a screening visual field test (threshold related) the CPT code is 92082, and the Medicare allowable is $52.11.

3. For a visual field test-full threshold field the CPT code is 92083. Reimbursement is $56.46.

Most O.D.s perform the full threshold test, for which Medicare reimbursed $45 last year, more than $10 less than today.

When documenting for this test, complete a separate interpretation and report form. Many practices omit this. Include a copy of the field itself. Without these components, your documentation will be considered substandard.

* Gonioscopy. The CPT rode for this test is 92020. Document the visible angle structures in the patient's medical record for this test, which is bilateral.

Last year, Medicare allowed reimbursement of about $25 for this procedure; this year, the allowable is up to $31.86. Gonioscopy may be billed with 92XXX or 99XXX office codes.

* Fundus photography. The CPT code for this bilateral test is 92250. Complete a separate interpretation and report; include the photographs in the patient's medical record. Include the following on the photos: the patient's name, date, the eye which was photographed and the diagnosis. Provide a written interpretation of what the picture shows and include it in the record.

Last year, Medicare reimbursed approximately $30 for fundus photography. This year, the amount has risen to $58.32.

* Serial tonometry. You can bill separately for this in addition to the office visit. Serial tonometry, which is coded as 92100, used to be bundled with the 92XXX eye codes. Now, this code can be piggybacked with a 99XXX code or a 92XXX code, and you'll be reimbursed.

The Medicare allowable for this procedure was $45 in 1999; this year it's $52.75.

* Scanning laser. This test evaluates the topography of the optic nerve head and the nerve fiber layer. It's a new approval for '99. The CPT code is 92135 and is unilateral. This procedure also requires a separate interpretation and report.

In 1999, the Medicare allowable was about $29 for this test; this year, it's $67.48 per eye.

* Remember, you can't charge your Medicare beneficiaries more than your non-Medicare patients. You mustn't have two fee schedules.

MEASURING INTRAOCULAR PRESSURE

Three's a Charm

By J. James Thimons, O.D., Fairfield, Conn., and Anthony B. Litwak, O.D., Baltimore, Md. Intraocular pressure (lOP) can vary with the time of day, and from day to day in glaucoma and glaucoma suspect patients. For this reason, it's important to take at least three IOP readings and establish a baseline pressure before starting a patient on glaucoma therapy. We generally recommend taking two morning pressures and one afternoon reading. The average diurnal fluctuation of IOP in glaucoma patients is 4 to 6 mm Hg and can exceed 10 mm Hg. Many patients labeled with normal tension glaucoma will exhibit an IOP spike if enough IOP readings are obtained. When judging the effectivity of glaucoma medications, we compare three IOP readings on medicines with the untreated baseline readings.

Dr. McGreal is center director at the Missouri Eye Institute, a VisionAmerica co-management center in St. Louis. He lectures frequently on clinical and practice management topics.

Copyright Boucher Communications, Inc. May 2000
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