Optometry Coding & Billing Alert

Published on Fri Jun 20, 2008 PDF

Question: Our optometrist saw a glaucoma patient and performed a gonioscopy. The optometrist also took slit lamp photographs to document an iris nevus during the same session. Can we report the procedures separately?

Kentucky Subscriber

Answer: Normally, you cannot report a gonioscopy and slit lamp photographs together because Correct Coding Initiative (CCI) edits forbid it. On the other hand, you can report the two services separately using modifier 59 (Distinct procedural service) and separate diagnosis codes in certain circumstances.

Because the optometrist performed the gonioscopy and the slit lamp photos for different reasons, you can report both procedures:

- Link the appropriate iris nevus diagnosis code (224.8, Benign neoplasm of eye; other specified parts of eye) to 92285 (External ocular photography with interpretation and report for documentation of medical progress [e.g., close-up photography, slit lamp photography, goniophotography, stereo-photography]) for the photos.

- Attach modifier 59 and the appropriate glaucoma diagnosis code (365.x) to 92020 (Gonioscopy [separate procedure]) to represent the gonioscopy. You should also document the physician's findings and the condition's status in the interpretation and report for the test.

Why? The modifier tells the insurance carrier that the iris nevus and gonioscopy were separate procedures, not components of one another. Because 92020 appears in column 2 of the CCI edits, append the modifier to that code and not 92285, which is the column 1 code.