One of the fastest growing areas of optometry is dry eye. For those of you ready to build a dry eye subspecialty, you also need to know how to code for it, including office visits, procedures and technologies. Here are the basics for coding dry eye visits:
Office visits. In general, the E&M codes (992XX) are the most appropriate for dry eye–related visits. The 92012 intermediate ophthalmic code can also be used if the CPT definition is followed. From a telehealth perspective, G2010 (recorded image evaluation and interpretation), G2012 (virtual check-in) and 99421-423 (online digital evaluation) may be appropriate.
Meibography vs. photography. In January 2019, meibography was given a new category III code of 0507T, defined as near infrared dual imaging (i.e., simultaneous reflective and transilluminated light) of meibomian glands, unilateral or bilateral, with interpretation and report.
Category III codes, by definition, are rarely covered by third-party carriers and are generally patient-paid.
Anterior segment photography remains the same, CPT 92285, defined as external ocular photography with interpretation and report for documentation of medical progress (e.g., close-up photography, slit lamp photography, goniophotography, stereo-photography).
Both procedures require proper medical necessity to perform, and interpretation and report.
Lid procedures. Numerous new lid procedures are available, each with their own coding rules.
BlephEx, or mechanical debridement of the eyelids, currently doesn’t have a code. Nonetheless, you still have to code it. Just because a specific technology or procedure doesn’t have a specific CPT code assigned to it doesn’t alleviate the medical record documentation or coding of it. Fortunately, the CPT allows for this situation with unlisted codes. CPT code 92499, unlisted ophthalmological service or procedure, is designed for situations where an ophthalmic procedure is performed but doesn’t have its own code. This would be the most appropriate code to use for a BlephEx procedure.
Thermal lid procedures such as iLux (Alcon) would also fall into this category. Some argue that 67999, unlisted procedure-eyelids, would be the proper code; however, the code begins with “67,” designating it as a surgical procedure. Because these tools are not surgical in nature, 92499 is the most appropriate.
LipiFlow (Johnson & Johnson Vision Care) and TearCare (Sight Sciences) are different because they have their own category III codes:
- LipiFlow (0207T) – evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral.
- TearCare (0563T) – evacuation of meibomian glands, using heat delivered through wearable, open-eye eyelid treatment devices and manual gland expression, bilateral.
The definition of each code is unique to the technology.
Intense-pulsed light (e.g., Lumenis) does not have its own CPT code, so 17999, unlisted procedure, skin, mucous membrane and subcutaneous tissue, would be the most appropriate.
Unlisted codes do not have any RVUs attached to them, and no standard coverage or reimbursements exist. Most are patient-paid. If you are submitting an unlisted code, the claim should include a letter of medical necessity, a specific description of the procedure and justification of your charges.
CLIA-waived POC Tests
Testing osmolarity and MMP-9 is now commonplace for dry eye. Getting your CLIA waiver is easy, as is coding for the tests.
The TearLab osmolarity system is best described using CPT 83861, microfluidic analysis using an integrated collection and analysis device, tear osmolarity. It is a unilateral or single-unit test, so billing one test for each eye is appropriate.
InflammaDry (Quidel) is best described using CPT 83516, immunoassay for analyte other than infectious agent antibody or infectious agent antigen, qualitative or semiquantitative, multiple step method. It also is a unilateral or single-unit test and follows the same billing method for each eye.
If you know the basics for specific procedures using CPT and category III codes, you can protect your practice’s finances and compliance.
Send your coding questions to firstname.lastname@example.org.