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Ocular Surface Management

Breaking down the proper codes

JOHN RUMPAKIS, O.D., M.B.A.

Managing the ocular surface is a dynamic and exciting area of practice. New technologies, such as tear film interferometry and other diagnostic tests, provide new diagnostic information that wasn’t widely available a few years ago.

That said, many practitioners wonder how to properly code for these procedures. Let’s break it down.

The office visit

I am always asked, “Is using a 992XX or a 920X2 code better to use for an ocular surface patient encounter?” The bottom line is that there is no difference between dry eye, cataracts or even a retinal problem in that they are all recognized disease processes that require proper anatomical assessment of structure and function. So, we are required by the rules of the CPT to always use the code that most appropriately represents the services actually provided in the medical record.

When any physician performs medical eye services, the first area of the medical record that should be assessed is that of the Chief Complaint (CC). The CC must reflect the reason for visit, either (a) patient directed, as a complaint or symptoms of an eye disease or injury, or (b) at the direction of the physician to return to the office for a very specific reason.

Determining the specific CPT code to use is fairly simple. In the 920XX codes, it would be most likely that only the intermediate codes 92002 or 92012 would be appropriate. However, if a 92012 is used, the patient must present with a new condition or an existing condition complicated with a new diagnostic or management problem not necessarily relating to the primary diagnosis.

In other words, because most patients in this scenario would be established patients, and unless patients present with a new condition or additional complications relating to dry eye not previously noted, the 92012 would not be appropriate to use, as the definition of the code would no have been met.

That would leave the 992XX codes. The beauty of the 992XX codes is that they are structure-driven. You, as the physician, get to determine the clinically relevant and pertinent anatomical areas to examine and evaluate based upon the patient’s presentation or what you asked the patient back to the office for. The level of history and medical decision making are, in most cases, fairly specific and limited.

In most dry eye cases, the coding used in the 992XX system would be 99201, 99202, 99212 and 99213. Always code each patient encounter by the individual case presentation and the individual patient you are examining and treating.

Diagnostic testing

In general, many of the traditional diagnostic tests performed for “dry eye” are not separately identified by the CPT or HCPCS and are considered part of the office visit billed when these tests are performed. Schirmer, Phenol Red Thread, TBUT and Tear Prism Analysis are tests that fall within these parameters.

However, the following newer technologies are separately identified by either a Level III HCPCS code or a new CLIA-waived procedure and are able to be coded in addition to the office visit.

• InflammaDry: CPT code 83516, immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semi-quantitative, multiple-step method, is a CLIA-waived test (be sure to use the modifier –QW on each procedure performed) that can be performed in O.D. offices where the practice has a clinical lab designation and a physician with the practice has been registered as a clinical lab director. The current national payment amount for this lab test is $15.70 per eye. (Please be aware that there are currently draft LCDs that are in the process of being published by Medicare Administrative Carriers around the country that will not allow CPT code 83516, among other codes, to be used for dry eye diagnosis as of the date of this writing.)

• LipiView: 0330T – Tear Film Imaging, Unilateral or Bilateral, with interpretation and report. This is a temporary use or “tracking code” for tear film interferometry and, as such, it needs to be reported to the carrier, though it is generally a patient payable test and, thus, has no set reimbursement schedule. There are coordinating rules with CPT code 92285 (anterior segment photography) for this code that one needs to be aware of when performing it.

Great rewards

New technology is always exciting when it can be employed and provides new avenues for exceptional patient care. Following the CPT guidelines and the rules surrounding CLIA-waived testing allows you to provide care for your patients at the highest level and add a unique and rewarding area of specialization to your practice. OM

DR. RUMPAKIS IS FOUNDER, PRESIDENT AND CEO OF PRACTICE RESOURCE MANAGEMENT, INC., A CONSULTING, APPRAISAL AND MANAGEMENT FIRM FOR HEALTHCARE PROFESSIONALS. E-MAIL HIM AT JOHN@PRMI.COM, OR VISIT TINYURL.COM/OMCOMMENT TO COMMENT.