Ophthalmology and Optometry Coding Alert

Question: A patient who has had LASIK surgery now has cataracts. One of our ophthalmologists performed topography to calculate the IOL power. Which diagnosis code should we use for the topography? The cataract diagnosis (366.16) is not listed as a covered code for that diagnostic service.

Texas Subscriber

Answer: Some carriers accept ICD-9 code V45.69 (Other states following surgery of eye and adnexa), indicating previous LASIK surgery, as a covered diagnosis for corneal topography. However, some carriers, such as Noridian (the Part B carrier for 12 Midwestern and Western states), specify that V45.69 must be accompanied by diagnosis code 367.21 (Regular astigmatism) or 367.22 (Irregular astigmatism). Check with your carrier to see if it has such limitations.
 
Corneal topography is an alternative method for determining IOL power in cases in which previous LASIK surgery makes it difficult to use an A-scan or IOL Master. Since there is no specific CPT code for corneal topography, Medicare requires you to report an unlisted-procedure code, 92499 (Unlisted ophthalmological service or procedure). Type "corneal topography" into the comments area or Box 19 on your claim form and send a description with the claim. Non-Medicare carriers may accept HCPCS code S0820 (Computerized corneal topography, unilateral).