Approximately 2.8 million Americans have been diagnosed with glaucoma, according to the American Health Assistance Foundation. As a result, it’s important to know how to properly code and bill when dealing with this disease.
Glaucoma coding consists of billing for gonioscopy, fundus photography, pachymetry, scanning imaging, serial tonometry, and visual fields. The chart below gives a quick look at common CPT codes, while the following guidelines help during billing.
CCI The CPT codes 99211 (office or other outpatient visit) and 92285 (external ocular photography) are not usually billed with 92020, but Medicare’s Correct Coding Initiative (CCI) shows they can be if the procedures are distinct or independent from each other. This means the procedure must represent a different patient encounter or different anatomical site.
The same can be said for 92100 and 92083 when it comes to billing with the 99211 code—they can only be billed if the procedures are distinct or independent. Here’s where it gets a little complicated. The CCI shows that 99211 is billable with the scanning imaging 92132 code, but is not usually billed with the two 92133 or 92134 imaging codes. However, both 92132 and 92250 may be billed with 92133 or 92134 if again the procedures are distinct or independent. According to CCI, 92133 and 92134 are not billable together under any circumstance.
MODIFIERS Medicare considers all these glaucoma codes, excluding 76514, as bilateral codes and no modifiers are needed whether done on one or both eyes. However, non-Medicare plans may not agree. Certain non-Medicare plans also pay unilaterally for 76514.
FREQUENCY Procedures under 92020, 92250, 92100, and 92083 are usually performed yearly on glaucoma and glaucoma suspects. These procedures can be repeated if the following occurs: new symptoms, disease progression, new findings, unreliable prior results, change in treatment plan, or when medicine is added, subtracted, or changed.
For 92250, some Medicare carriers with a Local Coverage Determination might limit its frequency. Dilation for fundus photos may also be required. Some Medicare carriers limit the 76514 code for glaucoma to once in a lifetime. The frequency of scanning imaging procedures can also be restricted. And remember, if you are renting a scanner, bill it as you owned the machine.
Don’t forget that every time these tests are performed on the patient, it has the potential to be billable.
Alan Homestead is an optometric physician practicing in Seattle and a consultant on coding issues and practice management.