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Ophthalmology and Optometry Coding Alert

Reader Question:

Check Medical Necessity Rules for 92025

Published on Fri Jul 08, 2011

Question: What are the rules are for coding corneal topography? I can't find a CPT® code for it. Should I just use 92499? The corneal topography was done on a keratoconus patient. California Subscriber Answer: For corneal topography, report 92025 (Computerized corneal topography, unilateral or bilateral, with interpretation and report). You do not need to resort to 92499 (Unlisted ophthalmological service or procedure). Check with your carriers for their rules on demonstrating medical necessity for this procedure. For example, Medicare Part B carrier Cigna has published a local coverage determination (LCD) listing these diagnoses for which 92025 would be medically necessary: 367.22 -- Irregular astigmatism 371.00 -- Corneal opacity, unspecified 371.23 -- Bullous keratopathy 371.50 -- Corneal dystrophy, unspecified 371.52 -- Other anterior corneal dystrophies 371.57 -- Endothelial corneal dystrophy 371.60-371.62 -- Keratoconus 372.40 -- Pterygium, unspecified 996.51 -- Mechanical complication of other specified prosthetic device, implant, and graft; due to corneal graft V42.5 -- Organ or other tissue replaced [...]
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