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opthamology billing

  1. Exclamation opthamology billing
    Medical Coding Books
    I audit billing for payment for a physician who is at risk with Humana. Opthamology is not my speciality, although I am learning. I have physicians who are billing 99244, along with 92020, 92225, 92225, 92250. It is my understanding that the physician should not bill the consult along with all the procedures and are these procedures all necessary or is he unbundling. Please let me know.

    Last edited by quickmedbilling; 11-06-2007 at 08:32 AM.

  2. #2

    92020, Gonioscopy = Gonioscopy is a technique for examining the visually inaccessible anterior chamber angle, the drainage apparatus of the eye - the trabecular meshwork, and its anatomical relation to the adjacent iris. It represents a "bilateral" procedure.
    Evaluation of glaucoma (narrowness or closure of the anterior chamber angle, historical evidence of angle closure)
    Evaluation of growth or tumor in the angle
    Evaluation of suspected neovascularization of the angle.
    Evaluation of uveitis.
    Evaluation of conditions affecting the ciliary body.
    Evaluation of degenerative conditions affecting the anterior segment
    History or signs of penetrating ocular foreign body
    Assess peripheral anterior synecchiae (PAS)
    Evaluation after trauma for angle recession
    DX Codes that support Medical Necessity MUST be linked to procedure.

    92225, 92250 - Helpful Link

    92225, Initial Bilateral/92226, LT/RT = Definition:
    Examination of the interior of the eye, including the lens, retina and optic nerve, by indirect or direct ophthalmoscopy. Indirect ophthalmoscopy employs a head lamp device to shine a very bright light into the eye. This is generally done by an ophthalmologist.

    92250 = Definition:
    Fundus photography with interpretation and report to document a disease process or follow the progress of a disease, photographs may be necessary. Photographs may also be necessary to plan treatment for a disease process.
    Inherently bilateral.
    Again, ICD9 MUST support the use of procedure, frequency.

    All of these services are appropriate means of diagnosing, establishing treatment plan, etc. I think that it would be appropriate to bill out these other services with a consult (with modifier when done w/ gonio), if documentation supports the medical necessity, are "separately identifiable", etc.

    Hope this helps you & Good Luck!
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  3. #3
    Sorry to intrude on your question but I have a question regarding a Slit Lamp exam. This was performed in an Urgent Care facility. No FB removal was involved. Is that part of the E/M code or should it be coded differently?

  4. Smile Danielle Charlebois, Professional Coder
    The slit lamp exam for cornea, anterior chamber, and lens are part of an E/M exam per 1997 guidelines. I hope that helps shed some light.

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