Keeping up with the coding changes for new technologies is necessary to be properly reimbursed.
Still, the basic procedures for glaucoma care have not changed. A dilated fundus examination should be performed every six to 12 months and intraocular pressure examinations performed every three to four months. These examinations could be coded using the appropriate 99000 evaluation and management codes, or the 92000 ophthalmic code series.
Special testing is necessary at specific intervals. Pachymetry (76514) is required during the initial diagnostic testing. Stereoscopic fundus photography (92250) should be performed annually or as optic nerve changes are suspected. Visual field testing (92083) is performed from one to four times a year (depending on disease severity). Posterior scanning laser imaging (92135) is performed one to four times a year (also depending on disease severity). Gonioscopy (92020), often neglected, should be done annually.
Anterior scanning laser imaging (0187T) may be necessary to view the anterior chamber and angle. This code may or may not be paid by insurance carriers because it is a CPT Level III code used for developing technologies. Currently, anterior scanning laser does not take the place of gonioscopy. Some Medicare carriers have articles or local carrier determinations (LCDs) addressing coverage.
Ocular blood flow analysis (0198T) is another evolving technology that may become a standard test in the future. Again, this is a CPT Level III code that may or may not be paid. Some Medicare carriers have LCDs on ocular blood flow.
Perform serial tonometry (92100) when you need to determine an IOP diurnal curve pattern for a particular patient. This is generally not coded in conjunction with any other testing or evaluation services.
Extended ophthalmoscopy (92225, 92226) could be performed in place of fundus photography. Most Medicare carriers require an anatomically correct drawing of a specific size to be done, along with an interpretation and report when using this procedure. With the technology available today, this procedure is rarely used.
Documentation Details
An order for each testing procedure needs to be written in the Plan section of the chart. Remember that medical necessity is the prevailing rule—if the necessity of the test is not specified in the medical record, then the test is at risk for denial on a post-payment review. Remember to record in the medical record not only what you want to do, but also why you want to do it.
If any CPT code description indicates “with interpretation and report,” you are required to write a separate interpretation and report (I&R) for that procedure. This I&R should be in a separate section on the examination form or the electronic record. An I&R does not have to be on a separate page, and it does not have to be elaborate or long; however, it does need to state the findings and state what the findings indicate.
Scheduling the procedures required to diagnose and properly monitor a glaucoma patient can be a challenge. Some procedures cannot be performed together. For example, posterior scanning laser and fundus photography are not typically allowed on the same day, according the CMS Correct Coding Edits. Scheduling these tests for separate visits gives the provider numerous opportunities to measure IOP and gauge the effectiveness of the therapy.
The standard of care for a glaucoma patient requires a provider to understand the proper documentation and coding for multiple procedures. Take the time to keep up with the advances in technology, and know the coding and documentation that goes hand in hand with the new technologies in order to maintain the proper standard of care for your glaucoma patients.
