coding strategy

Tips for Topographers

Understand the three required components for correct coding.

JOHN A. MCGREAL JR., O.D., AND JON WEEDING

Corneal topography is used to guide suture removal to reduce astigmatism after penetrating keratoplasty. It assists in IOL calculations before cataract surgery, contact lens fittings and in the diagnosis of corneal diseases, such as keratoconus. (See “Topography: A Definition,” page 71.)

Here are the three required components for correct coding:

1. Medical necessity

Corneal topography is considered medically necessary with any of the following conditions:

1. Pre-operative evaluation of irregular astigmatism for IOL power calculation before cataract surgery

2. Monocular diplopia

3. Diagnosis of keratoconus

4. Post-surgical or post-traumatic astigmatism (>3.5D)

5. Suspected irregular astigmatism based on retinoscopic reflex or keratometry

6. Post-penetrating keratoplasty

7. Post-surgical or post-traumatic astigmatism

8. Certain corneal dystrophies (e.g. corneal dystrophy: microscopic cystic; corneal dystrophy: ring like)

9. Complications of transplanted cornea

10. Post-traumatic corneal scarring

11. Pterygium and/or corneal ectasia causing visual impairment

2. Specific CPT/ICD-9 codes

The CPT code for computerized corneal topography, unilateral or bilateral, with interpretation and report is 92025. The Medicare allowable fee for 2013 in our region is $37.56. The ICD-9 codes that support medical necessity in our region are listed in Table 1 below. Be sure to check your local carrier decision for the specific details of coding in your area. We recommend a periodic review of your Medicare carrier’s website, specifically examining the Medicare Coverage Database (www.cms.gov/medicare-coverage-database/) about any given CPT code. Also, keep in mind that other managed care plans may have similar or modified versions of Medicare’s requirements, so contact the plans to which you belong to ensure correct coding.

3. Patient medical record

The patient’s medical record should clearly state the diagnosis of the condition requiring a topographic image, as well as the order for the test. Documenting the professional interpretation and report is a necessary component when billing for corneal topography. When services are performed in excess of established parameters, they may be subject to review for medical necessity. Repeat testing is only indicated if a change in vision occurs with one of the conditions listed as an indication. Corneal topography should not be reported with or during the post-operative period for corneal procedures.

A caveat

Services performed for screening purposes or in the absence of associated signs, symptoms, illness or injury, as indicated above, will be denied as “non-covered.” For cases in which you perform corneal topography for screening or do not meet the established criteria, an ABN may be required for the patient. OM

DR. MCGREAL PRACTICES AT MISSOURI EYE ASSOCIATES IN ST. LOUIS, MO. E-MAIL HIM AT MCGREALJOHN@GMAIL.COM. MR. WEEDING IS PRESIDENT OF COMPLIANCE SPECIALISTS, INC., A BILLING AND CODING COACHING FIRM. E-MAIL HIM AT JON@CSEYE.BIZ, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.