Ophthalmology and Optometry Coding Alert

Question: Can you file an office visit with 92100 (serial tonometry)?

Question submitted anonymously

Answer: You not only can, but you should. You cant use the ophthalmological codes (92002, 92004, 92012, 92014) with 92100 -- at least with Medicare -- because serial tonometry is bundled into these codes. So the only way you can get reimbursed for 92100 as well as an office visit is to use one of the E/M services codes. You dont need a -25 modifier unless youre doing a minor surgical procedure; this is diagnostic, so you dont. Note that this doesnt guarantee payment. Some carriers feel that serial tonometry is a diagnostic procedure for a new patient, and therefore will only pay for it with a new-patient office visit (99201-99205). If you try to code both an office visit with an established patient (99212 - 99215) and 92100, the insurance company may feel that the serial tonometry is routine, and downcode you to an ophthalmological code -- most likely, 92012. If the plan separates ophthalmology coverage from other medical/surgical coverage, then you may get downcoded as well. Still, you should code both the office visit and the 92100.