For the optometrist to receive timely reimbursement and withstand an audit from Medicare for caring for their glaucoma patients, there are requirements they must adhere to. This column discusses these requirements.

Limited Testing

Medicare, including many insurance payors, discourage the use of more than one diagnostic/management tool on the same day. This is due to the National Correct Coding Initiative (NCCI) edits and payment policies, which aim to prevent perceived duplication of services when multiple imaging modalities are used for the same purpose on the same day.

So, when, specifically, does Medicare allow for commonly used diagnostic tools associated with glaucoma? The answers are below, with accompanying CPT codes:

• Visual field (VF) testing (92083). This extended examination used to assess peripheral vision loss is permitted to be performed yearly. It can be done more frequently based on the severity and/or reliability of the scan. It is at the doctor’s discretion to determine the cadence of follow-up appointments. 
• Optical coherence tomography (OCT) (92133 - optic nerve; 92134 - retina). Used to evaluate the optic nerve head, retinal nerve fiber layer, and ganglion cell complex, this OCT test is permitted to be performed once a year, though could be used more, depending on disease severity and progression. (For additional information, Google “NCCI Procedure-to-Procedure Lookup.”)

It’s worth noting that there is a new code for OCT-A of the retina: 92137. It cannot be billed with the other OCT codes 92133/92134 (see NCCI edits). This test can be run based on severity of retinal diseases. 

• Gonioscopy (92020). Employed to assess the anterior chamber angle to distinguish open-angle glaucoma from narrow-angle glaucoma, this is permitted to be performed yearly.
• Serial tonometry (92100) or dynamic tonometry (92145). This can be employed to measure IOP on a case-by-case basis. Some insurers may limit the frequency of serial tonometry to within a year. For instance, certain Medicare carriers limit this procedure to once per doctor per a lifetime, while others cover it once a year.
• Fundus photography (92250). Used to document optic nerve appearance for baseline and progression analysis, this is permitted to be performed annually.
• Pachymetry (76514). This ultrasound technology used to measure corneal thickness is permitted to be performed yearly.
• OCT scan of the anterior segment and angle (92132). Many insurers, including Medicare, consider it medically reasonable and necessary to perform this procedure up to 2 times per year for covered indications. (See “Frequently Asked Questions,” below.)
• Electroretinography (ERG) test. ERG is used to monitor the retinal ganglion function and can aid in detecting early dysfunction. It is helpful in monitoring the progression of glaucoma, especially in patients who do not produce reliable visual fields. The CPT code used is 92273. Glaucomatous optic atrophy H47.23 is the ICD-10 code that is recognized by payors. The test can be run based on severity and unreliability of fields. 

Chart Documentation

To withstand an audit, the OD must document in the patient’s chart:

• A clear indication for the diagnostic/management tool, such as a glaucoma diagnosis.
• Their findings, such as cupping, atrophy etc.
• An interpretation and report for the used diagnostic/management tool.

An example: “The right eye VF test shows a superior arcuate defect consistent with glaucomatous optic neuropathy. There is no sign of progression since the last test. I will continue monitoring this patient with VF testing every 6 months. I will also instruct the patient to maintain their IOP-lowering treatment and to schedule a VF and IOP check in six months.”

A Welcomed Outcome

By understanding the relevant CPT and International Classification of Diseases, Tenth Edition (ICD-10) codes and maintaining thorough documentation, the optometrist will be reimbursed for their services to the glaucoma patient, while protecting themselves from an audit. OM

Tonya M. Reynoldson, OD, MBA, OD, MBA, is a senior eye care director for AEG Vision. She currently supports over 100 ODs with clinical needs such as billing and coding questions, EHR training, continuing education needs and clinical staff training to create the best patient outcomes. She previously owned two private practices for over 20 years before entering her current role.