coding q & a
What Medicare covers for glaucoma and how to get paid.
BY SUZANNE L. CORCORAN, C.O.E.
Medicare now reimburses glaucoma screening for certain patients. Here, I'll review what you need to get reimbursed.
What tests will Medicare cover?
Answer: The tests Medicare will cover include:
- visual fields (92081, 92082 and 92083)
- fundus photography (92250)
- gonioscopy (92020)
Medicare will also cover these less frequently used tests:
- serial tonometry (92100)
- ultrasound biomicroscopy
- B-scan biometry (76512)
- scanning laser ophthalmoscopy (92135).
What are the documentation requirements for diagnostic tests?
Answer: Diagnostic tests share requirements to support claims for reimbursement. The common elements are:
- indications for testing, such as symptoms, suspected disease or chronic disease.
- an order for the test. (This should be part of your plan.)
- test results (e.g., photos, printouts, drawings, notes)
- interpretation of the test
- your signature.
The CPT descriptions of documentation requirements for many ophthalmic diagnostic tests include the phrase, ". . . with interpretation and report." This refers to a short narrative in the medical record that explains the test results (if possible). The interpretation should include test result reliability (e.g., whether the patient was compliant), as well as a diagnosis and the impact test results will have on the course of treatment (if any).
You don't have to write the report on a separate form or page but you should clearly define it as distinct from the other exam notes.
Does Medicare pay for these diagnostic tests with an office visit or with other tests?
Answer: With a few limitations, Medicare will reimburse an exam and a diagnostic test performed on the same day. It also covers concurrent testing, except that Medicare's National Correct Coding Initiative treats scanning laser ophthalmoscopy (SLO) and fundus photos as mutually exclusive, so you'd only be reimbursed for fundus photography. Many Medicare carriers also discourage performing SLO and visual fields on the same day.
How often can I perform these tests?
Answer: As often as medically necessary. The American Optometric Association has guidelines and many Medicare carriers have local medical review policies addressing some of these tests.
The numbers in the table below show the frequency of glaucoma testing from year 2000 data. A practice with a large percentage of glaucoma patients will likely have higher use than these averages.
Frequency of Glaucoma
Testing on Medicare
Beneficiaries by O.D.s
(per hundred eye exams)
|| Field 9%
SLO is still used infrequently because most practices don't yet own the equipment. However, SLO use is expected to increase because it's defined as "unilateral"; other tests are "bilateral."
With proper documentation and attention to medical necessity and frequency, you shouldn't have a problem getting reimbursed for the tests you run for glaucoma.
SUZANNE CORCORAN IS VICE PRESIDENT OF CORCORAN CONSULTING GROUP. REACH HER AT (800) 399-6565 OR VIA E-MAIL AT
Optometric Management, Issue: March 2002