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Resources: CPT Information

EyeGenetix sells ophthalmic diagnostic equipment to primary care providers. This equipment performs the following tests: Visual Field Tests, Tonometry and Fundus Photography.

 

CODING

 

EyeGenetix has chosen the following codes to describe the services performed:

• 92082 Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (eg, at least 2 isopters on Goldman perimeter, or semi-quantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, octopus program 33)
• 92140 Provocative tests for glaucoma, with interpretation and report, without tonography
• 92250-TC Fundus photography with interpretation and report

 

CPT Resource (Acuity Reimbursement)

 

There are no CCI (Correct Coding Initiative) edits with these codes or with an E/M (99201-99215) code attached. Therefore, all three codes can be used along with an E/M code without the use of the -59 modifier, for Medicare insurers. Private insurers may use their own proprietary rules, individual providers will need to check the insurance contracts for claim submission procedures.

 

Can these services be performed by a primary care physician or are they limited to optometrists and ophthalmologists?

According to the CPT, any physician can perform any CPT code, no specialty is excluded from performing any CPT code.

There is no restriction from Medicare/Medicaid that will limit the use of these codes by specialty. Some private payers may limit use however, we researched the top 20 insurers in the US today and did not find any restriction of use.

 

MEDICARE GLAUCOMA SCREENING

• Medicare offers annual coverage for glaucoma screening for beneficiaries in the following high risk categories:
• Individuals with diabetes mellitus
• Individuals with a family history of glaucoma
• African-Americans age 50 and over
• Hispanic-Americans age 65 and over

 

Medicare will pay for glaucoma screening examinations where they are furnished by or under the direct supervision in the office setting of an ophthalmologist or optometrist, who is legally authorized to perform the services under State law.

 

Screening for glaucoma is defined to include:

• A dilated eye examination with an intraocular pressure measurement; and
• A direct ophthalmoscopy examination, or a slit-lamp biomicroscopic examination.
• Payment may be made for a glaucoma screening examination that is performed on an eligible beneficiary after at least 11 months have passed following the month in which the last covered glaucoma screening examination was performed.
• G0117 - Glaucoma screening for high-risk patients furnished by an optometrist or ophthalmologist
• G0118 - Glaucoma screening for high-risk patients furnished under the direct supervision of an optometrist or ophthalmologist.
• The EyeGenetix system can only be used to bill G0117 and G0118, if performed by an Ophthalmologist or Optometrist.