Ophthalmology and Optometry Coding Alert

Question: Our doctor saw a patient for droopy eyelids, and to determine the extent to which her droopy eyelids interfered with her vision, he performed two bilateral visual field tests on the same day (Humphrey full-field 120 point). The doctor performed the first field test normally, and the second after taping the patient's eyelids. The diagnosis is dermatochalasis (374.87). How should we code for this procedure? The patient has a commercial insurer that mirrors the Medicare guidelines.

Pennsylvania Subscriber

Answer:  Most Medicare carriers want you to report just one code for visual field (VF) tests, even if an ophthalmologist needs to perform the test twice -- once with lids untaped and once with lids taped -- to confirm that the dermatochalasis is interfering with vision. Ophthalmologists often perform these tests prior to performing blepharoplasty procedures to correct the eyelid drooping.

For those carriers, report one unit of the appropriate 92081-92083 code (Visual field examination, unilateral or bilateral, with interpretation and report...). Since the definition states "unilateral or bilateral," report just one unit even when the ophthalmologist examines both eyes.

Some carriers will reimburse you for both tests because they mandate two VF tests to support the diagnosis and medical necessity for the surgery. If this is the case, you should append modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) to the second test and report the visual field code (92081--"92083) twice -- the first time with no modifier and the second time with modifier 76. You can add comments in Block 19 of the claim form (or the electronic equivalent) to indicate "taped and untaped."

Try this: One way to reduce the amount of time spent in visual field testing is to create a custom visual field that uses lots of points superiorly and only a few spots below the line of sight.