Ophthalmology and Optometry Coding Alert

Gonioscopy (92020), serial tonometry (92100), and sensorimotor examination (92060) were all bundled into the eye exam codes (92002, 92004, 92012, 92104) in 1998. This was under the Correct Coding Initiative (CCI), a national Medicare policy, and we covered the story in the first issue of OPC (December, 1998). But Medicare does allow local carrier bundles which are not found in the CCI under certain circumstancessuch as if they were long-standing before the CCI came into existencesays Lise Roberts, vice president of Health Care Compliance Strategies of Syosset, NY. Although the predominance of Medicare carriers do not bundle gonioscopy, serial tonometry, or sensorimotor exams into the E/M codes because they are not bundled under the CCI, a few Medicare carriers have had a long-standing local policy of bundling these services, Roberts explains.

We asked Roberts about this when Terry Reynolds, data supervisor for accounts receivable at University Eye Specialists in Warsaw, NY, contacted us after trying to bill gonioscopies along with E/M codes. We tried doing this, and we were rejected, says Reynolds. Medicare said we cant bill gonioscopies with E/M codes.

In fact, Blue Cross Blue Shield of Western New York, the Medicare carrier, issued a bulletin in July of 1993 which bundles quite a few services with the E/M services codes, as well as with the eye codes. These include gonioscopy, serial tonometry, and sensorimotor exams.

Bundles With E/M Planned by HCFA

Blue Cross Blue Shield of Western New York is about to be followed by all of Medicare in this policy. The intent of the Health Care Financing Administration (HCFA), which administers Medicare, is to bundle the gonioscopy, serial tonometry, and sensorimotor exam codes into the E/M codes under the Correct Coding Initiative, says Roberts. This is likely to become effective in the July 1, 1999 CCI update, she says. The American Academy of Ophthalmology is vigorously opposing this proposed CCI bundling, however, so there is some outside chance it wont happen, Roberts adds.

Also, remember that even if they do become bundled with the E/M codes in July, the -59 modifier may apply in some cases which would make the services separately billable, says Roberts. Typically this would be where the visit and the special ophthalmological service (i.e., gonioscopy, serial tonometry, or sensorimotor exam) have separate diagnostic reasons for their performance. Roberts gives this example: An examination is performed due to cataracts and macular degeneration because the patient is complaining of progressive decrease in vision. The patient also has glaucoma which has been controlled by medications, although today the intraocular pressure is elevated. The visit would have the cataract and macular degeneration ICD-9 codes associated with it and the gonioscopy would be linked to the glaucoma ICD-9 code. The -59 modifier (distinct procedural service used to alert Medicare to the need to unbundle in this case) would be appended to the gonioscopy.