Ophthalmology and Optometry Coding Alert

Vision rehabilitation, a growing field that presents many coding challenges for ophthalmologists and optometrists, has three main coding components:
 
1. The initial consultation to evaluate the problem, alternative treatments, and the patient's readiness for treatment
 
2. A series of possible diagnostic tests to explore the extent of the problem (i.e., where blind spots are)
 
3. The therapy.
Of the 3.5 million visually impaired Americans, many are Medicare beneficiaries. In fact, 21 percent of adults age 65 and older are affected by this condition, which is not correctable with eyewear. Low vision reduces the ability to function and can cause harm to a patient who may fall, suffer burns, confuse medications, or become injured in another way due to loss of sight. Visual rehabilitation therapy can help patients see and function, so lawmakers and the American Association of Ophthalmologists have been pushing Medicare to require coverage.
 
Some carriers cover vision rehabilitation. Many recognize that teaching people to function independently makes business sense; it costs less than more long-term assistance. But payment for vision rehabilitation, also known as low-vision therapy, by those carriers that cover it falls under close scrutiny for proper coding.
 
"Low vision is in the early stretch," says John Pinto, an ophthalmology consultant based in San Diego. He says that some carriers' recent decisions to cover low vision clearly make the treatment more appealing to a broad cross-section of ophthalmologists.
 
Carriers that cover vision rehabilitation require that surgical repair be considered first. However, for many causes of low vision, such as macular degeneration, the only surgery is laser treatment with Visudyne, which may not be effective and doesn't last. Document previous attempts at treatment, and indicate the level of success of these treatments.
 
Cahaba GBA, the Medicare carrier in Georgia, published a comprehensive LMRP for visual rehabilitation in August 2001. The LMRP requires an initial visit for low vision to document the cause of the disability, determine the degree of impairment, test functional ability for rehabilitation, and set a treatment plan.
 
In vision rehabilitation, the provider focuses on increasing the use of the remaining vision. There is no specific code or code set for vision rehabilitation. The ophthalmologist or optometrist must select the codes that are most appropriate.
Diagnostic Tests
Many physicians can perform the evaluation, but whether the patient proceeds with the therapy depends on a number of factors particularly the results of diagnostic testing. "We conduct the testing and take the evaluation right up to the point of rehabilitation," says Ron Frame, OD, who practices with Optometric Physicians of Parkersburg, in Parkersburg, W.V.
 
Testing is essential to determine the type and extent of vision impairment. After the initial consultation (99241-99245) or office visit (99201-99215, 92002-92014), the ophthalmologist proceeds to diagnostic tests [...]