Article Date: 11/1/2006

billing & coding
Coding for Clinical Technology

How to bill for the use of new instrumentation.


As a profession, I feel we optometrists are beginning to understand the value of our services and also that we are taking the steps necessary to ensure we are coding and billing correctly.

Still, I often feel like a broken record when I repeat phrases such as, "bill appropriately for each visit," or "you must count up the number of exam elements that you performed," or, one of my favorite lines that I often use when teaching optometry interns, "when was the last time you had an appointment with a medical doctor and you expected or received care free of charge?"

Coding for Clinical Technology

  *Corneal Pachymetry 76514 B  
**Corneal Topography or Unlisted Ophthalmologic Procedure 92499 (RT, LT) M  
Diagnostic Imaging
92135 (RT, LT) M I&R
External Ocular Photography 92285  B I&R
Fundus Photography 92250  B I&R
Ophthalmic Ultrasound
A-Scan Only, Quantitative
76511 B  
Ophthalmic Ultrasound B-Scan 76512 B  
Visual Field Limited   92081 B I&R
Visual Field Intermediate 92082 B I&R
Visual Field Extended 92083  B I&R
*   Add -52 to bilateral procedures performed unilaterally
**Corneal topography will get its own CPT code in January 2007
M   = monocular
B   = binocular
I&R   = interpretation and report

Spreading the word

Have you noticed how easy it has become to find information on the business of optometry and how to incorporate medical optometry and billing into your practice? I have several journal supplements on coding and billing for glaucoma, dry eye and even silicone hydrogel contact lenses on my desk that I received in the last year that serve as excellent references. I also receive several e-mail advertisements a week on continuing education conferences that are promoting the integration of medical concepts with business and coding concepts.

Recently, I was reading a practice management article on clinical technology by Gary Gerber, O.D. He astutely stated that by incorporating new clinical technology into your practice, there are obvious benefits to the care you provide to your patients. He also said these technologies benefit your practice by improving the practice image. I agree with this wholeheartedly.

That article prompted me to provide an update on how to code and get reimbursed when you incorporate new clinical technology into your practice. Remember, billing consistently and appropriately and having staff who are knowledgeable about the managed care plans for which you are a provider will also improve your practice image.

Details, details

First, determine the correct CPT code assigned to your new office instrumentation (see table 1). These codes are billable in addition to your evaluation and management code (992XX) or other office visit code (comprehensive eye exam or consultation codes). You must properly document medical necessity for the additional testing in the patient's record when you are seeking insurance reimbursement. Keep a record of statements like, "ordered nerve fiber layer analysis (GDX) due to optic disc pallor in both eyes." An auditor will easily find and understand these notes. Choose diagnosis codes that accompany and indicate medical necessity for your procedure code. For example, it would be hard to justify the medical necessity of performing corneal pachymetry with a retinal detachment diagnosis.

One or two?

Know if the procedure code is monocular or binocular. Monocular codes are billed twice when performed binocularly or should be accompanied by a -50 modifier. Add a -52 modifier to binocular codes performed monocularly. Some procedures require additional medical record documentation consisting of interpretation and a report of the data collected. For threshold visual field testing, this would include whether the testing was reliable. It would also include a brief summary of the threshold visual field printout. You can document this directly on the printout kept in the medical record or in your examination notes.

Optometric Management, Issue: November 2006