Pediatric Coding Alert

Question: Our pediatrician examined a patient’s eye using a Wood’s lamp. She placed a drop of alcane in the patient’s eye, then used a florescein strip and the lamp to look for a possible corneal abrasion. Is the use of the Wood’s lamp included in the evaluation and management (E/M) encounter, or can we report CPT^® code 92230 to bill the procedure separately?

Oregon Subscriber

Answer: CPT^® code 92230 (Fluorescein angioscopy with interpretation and report) would not be appropriate to use in this situation. That’s because it describes a procedure most commonly used in ophthalmology where the fluorescein dye is injected into a patient’s arm, which then enables the ophthalmologist to examine the patient’s retina.

The fluorescein strip you mention, however, is simply dripped into the patient’s eye. So, the two procedures are not the same, and you cannot use 92230 in this encounter.

Additionally, per CPT^® Assistant May 2008; Volume 18: Issue 5, “the examination and fluorescein dye test are included in the evaluation and management (E/M) service and are not reported separately.” This means you are correct in saying the work is folded into the E/M.

But, as CPT^® Assistant goes on to say, “the work involving the detailed eye examination and history may allow the reporting of a higher-level E/M code.”