Rapid technological advances are changing the way optometrists deliver clinical care in a big way. Earlier, more accurate diagnoses, better monitoring of chronic conditions and practice building opportunities are all great reasons to invest in new technology. But choosing which technology will help you deliver better care while maintaining a healthy bottom line is rarely easy. Let’s focus on OCT as an example.
OCT has been a mainstream part of optometric practice for nearly a decade. Some would even argue that is has become the standard of care for glaucoma and macular disease. Not surprisingly, in 2012, CMS updated the coding for OCT from a single code (92135) to three to further refine and define OCT usage:
- 92132: Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral
- 92133: Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve
- 92134: Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina
While these codes describe typical OCT functionality, other capabilities often built into the device require a better understanding of the coding rules and regulations. The three I hear about most often are:
1. Screening Exam
If your OCT has a specific screening mode, you may be able to use it to provide a non-medically necessary screening of the retina. Coding for this screening procedure would be defined as S9986 - Not Medically Necessary Service (patient is aware that service not medically necessary). Being a Level II HCPCS code, no reimbursement is typically associated with this code.
If your OCT doesn’t have a screening mode, you and your specific OCT manufacturer must find a clinically valid method for performing a procedure less detailed and invasive than a regular OCT. You cannot perform a full OCT capture, eliminate the interpretation and report and call it a screening.
2. Corneal Thickness and Contact Lens Fits
OCTs are already clinically indicated for the measurement of the angles or the crystalline lens, but many can also measure corneal thickness and help with contact lens fittings. While OCT may do a great job in measuring corneal thickness, the scan cannot be coded as corneal pachymetry, CPT 76514, which is defined as “ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness).” Instead, you must use CPT code 92132, for which there is generally no diagnosis that would support the procedure; you may also find that 92132 is often considered non-covered as experimental and investigational by many insurance carriers.
If you use your OCT for fitting a contact lens, you are also obligated to use CPT code 92132.
If your OCT can perform angiography, you may be tempted to code for and bill the added angiography component separately as CPT code 92499 (unlisted ophthalmological procedure). However, not only is this inappropriate, but it’s also against the CPT definition and interpretation. Instead, CPT code 92134 alone incorporates the angiography component in its base definition of the code, and no additional code is necessary. In fact, coding with both CPT 92499 and CPT 92134 represents a coding and billing error. If paid for both, you would be obligated to return the 92499 payment to the carrier, or to the patient if they paid the extra. An ABN is not appropriate to use, as it cannot be used to split a single service into two parts for the purpose of collecting additional payment from the patient.
With technology swamping the field of optometry, we must carefully evaluate which tools are worth incorporating into our practices—and knowing both the opportunities for better clinical care and the limitations of the coding definitions and rules is the key.
Send your coding questions to firstname.lastname@example.org.