Glaucoma Coding Made Easy

 Few ocular disease presentations present opportunities for such a wide array of diagnostic tests as glaucoma, which means management of this spectrum of disease is good for your patient and your bottom line. Understanding the state- or region-specific procedure codes, and the payor guidelines associated with them, requires time and study on your partbut this is the only way to understand the complexities of coding for glaucoma. Lets start by looking at the typical glaucoma codes.

Common Glaucoma Codes

92020: Gonioscopy

92083: Visual field, threshold

92135: Scanning computerized ophthalmic imaging, posterior segment

92250: Fundus photography

76514: Pachymetry

These are your workhorse procedures. Follow the guidelines and you should have no trouble being reimbursed for these services. Forget anything and everything youve heard from all the coding specialists out there (including me) about what you can or cannot do and how often you can do it. Go to the Centers for Medicare & Medicaid Services (CMS) website, your particular MAC payor (carrier) and individual insurance sites and read the guidelines or Local Carrier Directives (LCDs) for your individual state/region. Every MAC (carrier) is in the CMS-mandated process of re-evaluating all existing LCDs, so stay current.

Less Common Glaucoma Codes

92100: Serial tonometry

92120: Tonography

92140: Provocative tests for glaucoma

92230: Fluorescein angiography

92275: Electroretinogram

76511: A-scan biometry

Biometry of the eye is certainly underutilized in evaluating the effects of lens size and anterior chamber depth on outflow dynamics. Electroretinogram and fluorescein angiography may be emerging technologies in the early detection of optic nerve damage. Specific policies on reimbursement for these procedures can be found only by investigating the individual payor directives. If you believe in the medical necessity of the test, and educate the patient about this, he or she always has the option to pay out of pocket.

Unusual Glaucoma Codes

G0117: Glaucoma screening for high-risk patient furnished by physician

G0118: Glaucoma screening for high-risk patient furnished under direct physician supervision

0198T: Ocular blood flow measure

0181T: Corneal hysteresis determination

0187T: Scanning computerized ophthalmic imaging, anterior segment

The G codes are rarely used, but are available if applicable. G0117 would be the code used by optometrists. It consists of visual acuity, IOP measurement and a dilated fundus examination. The last three are Category III codes, considered investigational and typically not reimbursed by any payor. Be very cautious in using creative coding hereCPT clearly states that if a Category III code is established, you must use it, not the unlisted code or some close match.

I cannot emphasize enough the necessity of self study on this subject, and you must be familiar with the guidelines established by your carrier or payor. These guidelines should not significantly conflict with the American Optometric Associations Clinical Practice Guidelines or the American Academy of Ophthalmologys Preferred Practice Patterns.

As always, medical necessity must be clearly established in the record regarding which tests to run as well as when and how often to run them. In the end, every patient decision must be based on your determination of medical necessity, not how you get paid.