Optometry Coding & Billing Alert

Published on Fri Aug 27, 2010 PDF

Question: I know that Medicare looks at gonioscopy as a bilateral procedure. What about other carriers? Should I consider this an inherently bilateral code with all insurances?

Louisiana Subscriber

Answer: Although CPT doesn't specifically describe the procedure that way, most insurers do follow Medicare's lead and consider 92020 (Gonioscopy [separate procedure]) bilateral. The Physicians' Fee Schedule Database assigns 92020 a bilateral surgery indicator of "2," which means that Medicare has set the RVUs for gonioscopy based on the optometrist's performing it bilaterally.

If the optometrist performs the gonioscopy on just one eye, you will need to indicate to the insurer that the doctor did not do the full bilateral procedure. Append modifier 52 (Reduced services) to 92020

Smart step: If a non-Medicare insurer denies your claim, contact them to find out what their preference is for reporting 92020.