BUSINESS

  CODING STRATEGIES

CODING NEW TECHNOLOGY

THE NEED-TO-KNOW CODING POLICIES SURROUNDING CONTACT LENS WEAR

THERE HAS been significant advancement in technology related to the anterior segment of the eye. Technologies that help you fit contact lenses on corneas that were previously unfittable and diagnose ocular surface disease in individuals whose anatomical structure weren’t easily visible to the average clinician are now readily available. Often, O.D.s struggle when determining the proper codes to describe these new technologies; however, all it takes is an understanding of the current codes and their appropriate definitions and applications.

Contact lens coding: Properly coding new technologies that help you fit contact lenses and better assess the ocular surface involves knowing the rules, definitions and appropriate usage guidelines.

WHAT CODES DO I USE?

In most cases, newer technologies that allow to you examine the cornea in greater detail or to visualize anatomical structures, such as the meibomian glands, are best described with existing CPT codes you are very familiar with:

• 92285 - External ocular photography with interpretation and report for documentation of medical progress (e.g., close-up photography, slit lamp photography, goniophotography, stereo-photography)

• 92286 - Special anterior segment photography with interpretation and report; with specular endothelial microscopy and cell count

• 92025 - Computerized corneal topography, unilateral or bilateral, with interpretation and report

• 92132 - Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral

Often, new technology will not have a CPT code, but instead will be assigned a HCPCS Level III code, which is the appropriate classification for new technologies (more on this below). Examples include:

• O33T - Tear film imaging, unilateral or bilateral, with interpretation and report (i.e., LipiView)

• 0270T - Evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral (i.e., LipiFlow)

COMMON MISCONCEPTIONS

That said, there are many misconceptions about what can be coded and billed. For example, let’s examine a multipurpose diagnostic instrument that performs many functions, including:

• Corneal topography (CPT 92025)

• Anterior segment photography (CPT 92285)

• Zernike and Fourier analysis of the cornea

• Contact lens fitting (CPT 92310 and/or 92072)

• Keratometry

• Tear meniscus height

• Lipid layer thickness

• Meibomian gland imaging

• Tear film break-up time

• Pupillometry

As noted above, there are really only four possible CPT codes that could be generated with this instrument. All other tests are considered to be incident to the office visit and are not separately describable with a code, thus, are not billable to the patient or a carrier.

With that in mind, it is imperative for you and your medical record to meet compliance standards, as there are fundamental principles that must be met.

• Medical Necessity: It is incumbent upon the physician to demonstrate the medical necessity of each and every test you perform on a patient. Simply put: The medical record must clearly demonstrate that the service, procedure or test ordered and performed was absolutely necessary in order to diagnose, treat or monitor the treatment of the individual patient’s condition.

• CPT Guidelines: As we all know, HIPAA requires us to all follow the rules of the CPT, not just looking up the code. We are expected to know the characteristics of each code as well, including unilateral or bilateral, physician supervision, requirements of the interpretation and report, etc. The CPT also requires you to always use the code that most closely represents the service that has been performed with the patient, not based on reimbursement.

The CPT codes are a subset of the broader Health Care Procedural Coding System, or what is known as HCPCS. CPT codes are Level I HCPCS codes. For new technology that is submitted to the American Medical Association, codes are assigned that haven’t yet been approved are designated as Level III HCPCS codes or what is commonly known as a new technology or tracking code.

• CCI Edits: The CCI initiative is the federal set of policies that govern which tests can or cannot be performed on the same date of service based upon the consensus of the CPT, national and local policy edits, national societies guidelines and standard medical and surgical practices.

DECODED

Innovation in contact lenses and the technologies that allow you to fit them and prepare the ocular surface for contact lens wear is advancing rapidly. Though the excitement of incorporating new technology into your practice can be all encompassing, don’t forget that using the technology comes with rules, definitions and professional responsibility to use and describe it properly. OM

JOHN RUMPAKIS, O.D., M.B.A., is founder, president and CEO of Practice Resource Management, Inc., a consulting, appraisal and management firm for healthcare professionals. Email him at John@PRMI.com, or visit tinyurl.com/OMcomment to comment on this article.