Ophthalmology and Optometry Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: Can we bill gonioscopy with an eye exam? My Medicare bulletin states that I can, but it is from 1995.

Michigan Subscriber
              Answer: Gonioscopy (92020) is listed as a separate procedure in CPT. It can't be billed in addition to a more comprehensive service, such as a routine eye exam. If the gonioscopy is performed routinely, CPT will bundle the procedure into the eye exam.
 
If routine (performed even though the patient doesn't have a sign, symptom or known diagnosis that it  medically warrants), it should not be billed separately. It must also be medically necessary. A screening is not covered, but a gonioscopy is covered, because the patient is a diabetic, for example. Diabetic patients can develop rubeosis iridis (neovascularization of the iris), and gonioscopy is a primary diagnostic technique for this condition. It's also appropriate to code gonioscopy separately when the ophthalmologist notes that a patient has an anatomically narrow angle, 365.20.
 
Check your carrier's most current bulletin. Depend-ing on where you look in a stack of bulletins, you might find a different answer. In 1995, gonioscopy was not bundled into the eye exam. In 1999 much to the consternation of the ophthalmological community gonioscopy was bundled into the exam, and then in 2000 the bundle was removed. As a result, your 1995 document was "current," but if you had pulled out a 1999 document, it wouldn't have been.
 
Make sure you keep all documents on file and organize them with the most recent documents in front for easy access.