Visual Field Coding

epilcher

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Hello,

I am wondering if anyone has a good resource on coding visual fields? Particularly how to determine the levels? Some of the reports aren't very clear. Any help is appreciated!

Thank you!
 

Cheezum51

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I assume the following is what you're looking for. It's from "Ophthalmic Professional, July 2014 issue." As you can see, the levels can be determined by the specific test run, problem being tested or type of field testing equipment used. The I&R should mention the type of testing protocol used which would help you determine the level of field test.

The three levels of VF
92081 — Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or 7 equivalent)
92082 — intermediate examination (eg, at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33)
92083 — extended examination (eg, Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30 degrees, or quantitative, automated threshold perimetry, Octopus programs G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2).

Most common code​

The most common code among Medicare beneficiaries is 92083. Manual perimetry is an option here if three or more isopters are plotted and static checking is done within the central 30 degrees, but that’s uncommon nowadays. More frequently, this is a fully-computerized VF with monitoring during the test by the technician. The program performed and completed is important; if two tests are done, only a single code is normally billable per patient per day. The descriptor states it must be a quantitative threshold-based program; without this, a lower level code must be chosen. CPT does not restrict 92083 to full-threshold mode testing so fast-thresholding algorithms are acceptable. Swedish Interactive Threshold Algorithm (SITA) standard and SITA fast are also acceptable — even if done via blue-yellow, or Short Wavelength Automated Perimetry (SWAP).

Least common code​

92082 is the least common test for Medicare beneficiaries. It also has a manual option (two isopters only, or three or more, but without the static central checking). The automated, computerized testing options are for semi-automated, suprathreshold and screening strategies. The binocular Esterman test and some full-field screening tests are examples of 92082.

Lowest level code​

92081 is the lowest level of visual field test. Any test not meeting 92082 or 92083 falls at this level. While not usual in a glaucoma-based practice, it is quite common in oculoplastics to note the deficit caused by lids and brows. CPT Assistant, the companion to CPT, in September 2010 published that this is the appropriate level for lid surgery even though “two” (taped and untaped) of the same isopter is plotted. They also noted that 92081 is not billable twice in this instance. Occasionally, payers will allow code 92082 (or 92081 twice) in this scenario, but they are rare and you should verify it beforehand.

VF level checklist
■ Determine if threshold strategies are performed — not merely “suprathreshold.” If so, 92083 may be an option.
■ If suprathreshold strategy is the only method used, the VF level is either 92082 or 92081; 92083 is not an option.
■ For eyelid and brow visual fields, 92081 is the likely level and it may be billed only once for most payers.

Tom Cheezum, OD, CPC, COPC
 

epilcher

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Hi Dr. Cheezum,

Thank you so much for answering. I appreciate your expertise here and on the board. I guess absent a report, how would one determine the level? I look at the VF data, sometimes it will indicate the test type but sometimes it doesn't. Also, how can you tell how many isopters are run? I've searched high and low for a definition as it relates to CPT code description.

Thank you!
 

Cheezum51

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Personally, as the coder, it shouldn't be your responsibility to try to determine the level of VF done. The I&R should note the type of test done.

That being said, I can tell you that, as a doctor, I never ran less than an extended visual field, 92083, except for a patient who was being evaluated for possible eyelid surgery.

Tom Cheezum, OD, CPC, COPC
 
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