Coding Q & A
Coding for Visual Field Testing
Here are answers to common questions about this test.

BY SUZANNE CORCORAN, C.O.E.

What CPT code applies to visual field testing?
Answer: You can choose from three codes for visual fields (See table, below right).

Don't view the "unilateral or bilateral" designation as encouragement to test one eye today and the fellow eye 1 week later to elicit more reimbursement. That would be fragmentation and could be considered fraud.

What are the indications for visual field testing?
Answer: Order visual field tests to detect and monitor changes in the patient's peripheral vision that are a result of trauma, glaucoma, visual pathway disorders (such as lesions or tumors), optic nerve conditions, etc.

Typically, one field per year is warranted for borderline or controlled glaucoma, two per year for uncontrolled glaucoma and three for unusual cases such as patients who have only one eye. In general, this and all other diagnostic tests are covered "when medically indicated." Clear documentation of the reason for testing is required.

Most Medicare carriers have published policies with acceptable diagnosis codes. Glaucoma suspect (365.00) is a covered diagnosis in all published policies.

Sometimes you may feel that a visual field is merited even though the indications don't match Medicare's list. If, for example, a patient presents for a health maintenance exam (absent findings consistent with glaucoma), or you order the test more often than is customary, then Medicare may not cover it. The patient should sign an advance beneficiary notice (ABN) before testing so that, if necessary, you may bill him for the test.

What documentation do we need to support our claims for visual fields?

Answer: In addition to the visual field printout, the medical record should contain:

• an order for the test
• the date of the test
• reliability of the test (was the patient cooperative?)
• an interpretation of the results, with report
• the impact on treatment and prognosis
• your signature.

As of July 1, 2001, Medicare's supervision rules for many diagnostic tests changed. Visual fields now require only general supervision, which means that your presence isn't required when your employee performs the test in your office.

What are reimbursement amounts for performing this test?
Answer: In 2002, the national Medicare fee schedule includes $80.36 for 92081, $47.42 for 92082 and $73.48 for 92083. These amounts are adjusted by local wage indices in each area.

Why is the value for 92081 so high? It seems impossible that the limited test is valued more than the intermediate or extended test, and we believe this is an error that will probably be corrected in the future.

The next question often is, "Can I do a full threshold test and bill for a tangent screen?" Definitely, no. Deliberately billing for something you haven't performed is considered fraud.

Can we be paid for visual fields with an office visit or with other tests?
Answer: The National Correct Coding Initiative says that visual field codes aren't bundled with any other code even though they're mutually exclusive.

For example, if you performed a 92082 and, based on the results decided to perform a 92083, then you would bill for the test with the higher value (92083) and not for the lower-level code.

While it isn't bundled under NCCI guidelines, many Medicare local policies don't cover scanning laser ophthalmoscopy (92135) on the same day as a visual field.

What's normal use for this test?
Answer: Medicare utilization rates for claims paid in 2000 show that optometrists performed visual field tests 7% of the time -- that is, for every 100 eye exams performed on Medicare beneficiaries, Medicare paid eyecare practitioners for this test seven times.

SUZANNE CORCORAN IS VICE PRESIDENT OF CORCORAN CONSULTING GROUP. YOU CAN REACH HER AT (800) 399-6565 OR AT SCORCORAN@CORCORANCCG.COM.