coding for glaucoma & glaucoma suspects
DESCRIPTION
Coding for Glaucoma & Glaucoma Suspects. Coding for Glaucoma & Glaucoma Suspects. Glaucoma Risk Factors – file://localhost/Users/alanhomestead/Documents/My Documents A 2-25-13/Pathology, Education, Pharmaceuticals 8-15-08/Glaucoma/Tests Procedures/Risk/Glaucoma Risk Factors.xls. - PowerPoint PPT PresentationTRANSCRIPT
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
11
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
Glaucoma Risk Factors – Glaucoma Risk Factors – file://localhost/Users/alanhomestead/Documents/My D
ocuments A 2-25-13/Pathology, Education, Pharmaceuticals 8-15-08/Glaucoma/Tests Procedures/Risk/Glaucoma Risk Factors.xls
22
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
Office visit, 92 or 99Office visit, 92 or 99
Frequency:Frequency:-As medically indicated -As medically indicated (q 1mo, 3mo, 6mo, (q 1mo, 3mo, 6mo,
12mo)12mo)
-No limit on office visits-No limit on office visits
33
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
Special TestsSpecial Tests
Scanning Imaging (GDx, OCT)Scanning Imaging (GDx, OCT)
PachymetryPachymetry
Visual FieldsVisual Fields
Fundus PhotoFundus Photo
Serial TonometrySerial Tonometry
GonioscopyGonioscopy
Extended OphthalmoscopyExtended Ophthalmoscopy
44
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
Special TestsSpecial Tests
Scanning Imaging (GDx, OCT)Scanning Imaging (GDx, OCT)
PachymetryPachymetry
Visual FieldsVisual Fields
Fundus PhotoFundus Photo
Serial TonometrySerial Tonometry
GonioscopyGonioscopy
Extended OphthalmoscopyExtended Ophthalmoscopy
55
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
Scanning computerized ophthalmic Scanning computerized ophthalmic diagnostic imaging, diagnostic imaging,
9213292132 Anterior segment Anterior segment
9213392133 Posterior segment, optic nerve Posterior segment, optic nerve
9213492134 Posterior segment, retina Posterior segment, retina
66
Scanning Imaging Scanning Imaging
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Medicare LCDMedicare LCD
Noridian: Noridian: RetiredRetired
CGS: CGS: YesYes
WPS:WPS: YesYes
Novitas:Novitas: YesYes
Palmetto: Palmetto: NoNo
77
Scanning Imaging Scanning Imaging
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Medicare LCDMedicare LCD
Retired LCD: Retired LCD:
Guidelines not rulesGuidelines not rules
List of ICDs handyList of ICDs handy
No LCD: No LCD:
Clinical judgment allowedClinical judgment allowed88
Scanning Imaging Scanning Imaging
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Medicare LCDMedicare LCD
Diag. code = primary test of medical Diag. code = primary test of medical necessitynecessity
99
Scanning Imaging Scanning Imaging
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Non-MedicareNon-Medicare
Every plan has own rulesEvery plan has own rules
Clinical judgmentClinical judgment
May follow MedicareMay follow Medicare
1010
Scanning Imaging Scanning Imaging
Interpretation & ReportInterpretation & Report
YesYes
1111
Scanning Imaging Scanning Imaging
Interpretation & ReportInterpretation & Report - - MedicareMedicareAddress the findings, relevant clinical Address the findings, relevant clinical
issues, issues,
and comparative data (when and comparative data (when available)available)
1212
Scanning Imaging Scanning Imaging
Interpretation & ReportInterpretation & ReportSuggestions:Suggestions:
• • SuccinctSuccinct
• • Test reliability (patient compliant, quality of result)Test reliability (patient compliant, quality of result)
• • Results (better, worse or same)Results (better, worse or same)
• • Noteworthy findings Noteworthy findings
• • Diagnosis Diagnosis
1313
Scanning Imaging Scanning Imaging
Interpretation & ReportInterpretation & ReportSuggestions:Suggestions:
• • Impact on treatment Impact on treatment (no treatment, further test/surgery/consult, (no treatment, further test/surgery/consult,
continue/increase/decrease/stop/add meds)continue/increase/decrease/stop/add meds)
• • Impact on prognosisImpact on prognosis
• • Physician signature Physician signature
1414
Scanning Imaging Scanning Imaging
Interpretation & Report - LocationInterpretation & Report - LocationNo requirement for specific location of I&RNo requirement for specific location of I&R
I&R can be: I&R can be:
On the test printout/result On the test printout/result
On a separate paperOn a separate paper
In chart notes as discrete entry with other E/M In chart notes as discrete entry with other E/M servicesservices
1515
Scanning Imaging Scanning Imaging
Interpretation & ReportInterpretation & ReportShould be easily identified as I&R and Should be easily identified as I&R and
not part of exam not part of exam
Should be readily available in case of Should be readily available in case of audit audit
1616
Scanning Imaging Scanning Imaging
Unilateral / Bilateral Unilateral / Bilateral
CPT: CPT: unilateral or bilateralunilateral or bilateral
Medicare: Medicare: Bilateral since 1/1/11Bilateral since 1/1/11
Non-Medicare: Non-Medicare: No universal rule, may No universal rule, may follow Medicarefollow Medicare
1717
Scanning Imaging Scanning Imaging
CCI - Correct Coding Initiative CCI - Correct Coding Initiative
Code pairs which are not billed together Code pairs which are not billed together (usually)(usually)
1818
Scanning Imaging Scanning Imaging
CCICCI
92132 +92132 +9213392133 (-59 ok)(-59 ok)
9213492134 (-59 ok)(-59 ok)
9921199211 (-59 ok)(-59 ok)
1919
Scanning Imaging Scanning Imaging
CCICCI
92133 +92133 +9213292132 (-59 ok)(-59 ok)
9213492134
9225092250 (-59 ok)(-59 ok)
9921199211 (-59 ok)(-59 ok)
2020
Scanning Imaging Scanning Imaging
CCICCI
92134 +92134 +9213292132 (-59 ok)(-59 ok)
9213392133
9225092250 (-59 ok)(-59 ok)
9921199211 (-59 ok)(-59 ok)
2121
Scanning Imaging Scanning Imaging
CCI ExceptionsCCI ExceptionsDifferent anatomical site: R eye & L eye.Different anatomical site: R eye & L eye.
Different patient encounter on same day.Different patient encounter on same day.
Different lesion (disease).Different lesion (disease).
99211: Ok if extra tests ordered - VA, IOP, etc.99211: Ok if extra tests ordered - VA, IOP, etc.
2222
Scanning Imaging Scanning Imaging
Doctor Order Doctor Order
YesYesPhysician must clearly document in Physician must clearly document in
medical record his intent that the test be medical record his intent that the test be performedperformed
TC, 26 breakout indicates need for Doctor OrderTC, 26 breakout indicates need for Doctor Order
2323
Scanning Imaging Scanning Imaging
Supervision LevelSupervision Level
GeneralGeneral
Responsible doc must be somewhere on earth, Responsible doc must be somewhere on earth, but does not have to be in officebut does not have to be in office
2424
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
Special TestsSpecial Tests
Scanning Imaging (GDx, OCT)Scanning Imaging (GDx, OCT)
PachymetryPachymetry
Visual FieldsVisual Fields
Fundus PhotoFundus Photo
Serial TonometrySerial Tonometry
GonioscopyGonioscopy
Extended OphthalmoscopyExtended Ophthalmoscopy
2525
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
PachymetryPachymetry
7651476514Ophthalmic ultrasound, diagnostic; Ophthalmic ultrasound, diagnostic;
corneal pachymetry, unilateral or corneal pachymetry, unilateral or bilateral (determination of corneal bilateral (determination of corneal thickness)thickness)
2626
PachymetryPachymetry
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Medicare LCDMedicare LCD
Noridian: Noridian: RetiredRetired
CGS: CGS: YesYes
WPS:WPS: RetiredRetired
Novitas:Novitas: NoNo
Palmetto: YesPalmetto: Yes
2727
PachymetryPachymetry
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Medicare LCDMedicare LCD
LCD may say:LCD may say:
Once in a lifetime for Glc. Susp.Once in a lifetime for Glc. Susp.
No limit on non-glaucomaNo limit on non-glaucoma
Clinical judgment if no LCDClinical judgment if no LCD
2828
PachymetryPachymetry
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Non-MedicareNon-Medicare
Every plan has own rulesEvery plan has own rules
Clinical judgmentClinical judgment
May follow MedicareMay follow Medicare
2929
PachymetryPachymetry
Interpretation & ReportInterpretation & Report
NoNo
3030
PachymetryPachymetry
Unilateral / Bilateral Unilateral / Bilateral CPT: CPT: unilateral or bilateralunilateral or bilateral
however…however…
3131
PachymetryPachymetry
33rdrd Party Paying Unilaterally Party Paying Unilaterally (once (once each eye)each eye)
CignaCigna
First ChoiceFirst Choice
Regence – Blue ShieldRegence – Blue Shield
Bill it twice w/ modifier RT & LT, & paid Bill it twice w/ modifier RT & LT, & paid twicetwice
3232
PachymetryPachymetry
33rdrd Party Paying Bilaterally Party Paying Bilaterally (once for both (once for both eyes)eyes)
MedicareMedicare
Aetna Aetna (1 per life glc & susp)(1 per life glc & susp)
Premera – Blue CrossPremera – Blue Cross
UMP UMP (1 per life glc & susp)(1 per life glc & susp)
3333
PachymetryPachymetryCCI CCI NoneNone
Doctor OrderDoctor OrderYesYes
Supervision LevelSupervision LevelDoes not applyDoes not apply
3434
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
Special TestsSpecial Tests
Scanning Imaging (GDx, OCT)Scanning Imaging (GDx, OCT)
PachymetryPachymetry
Visual FieldsVisual Fields
Fundus PhotoFundus Photo
Serial TonometrySerial Tonometry
GonioscopyGonioscopy
Extended OphthalmoscopyExtended Ophthalmoscopy
3535
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
Visual FieldsVisual Fields
92081 Limited 92081 Limited (tangent screen, Autoplot, arc perimeter, or (tangent screen, Autoplot, arc perimeter, or
single stimulus level automated test) single stimulus level automated test)
3636
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
Visual FieldsVisual Fields
92082 Intermediate 92082 Intermediate (at least 2 isopters on Goldmann perimeter, or (at least 2 isopters on Goldmann perimeter, or
semiquantitative, automated suprathreshold semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test) automatic diagnostic test)
3737
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
Visual FieldsVisual Fields
92083 Extended 92083 Extended (Goldmann VF with at least 3 isopters plotted (Goldmann VF with at least 3 isopters plotted
and static determination within central 30 and static determination within central 30 degrees, or quantitative, automated threshold degrees, or quantitative, automated threshold perimetry, Humphrey full threshold 30-2, 24-2, perimetry, Humphrey full threshold 30-2, 24-2, or 30/60-2)or 30/60-2)
3838
Visual FieldsVisual Fields
Indications, Diagnosis Codes, Frequency Indications, Diagnosis Codes, Frequency Medicare LCDMedicare LCD
Noridian: Noridian: RetiredRetired
CGS: CGS: YesYes
WPS:WPS: YesYes
Novitas:Novitas: YesYes
Palmetto: Palmetto: NoNo
3939
Visual FieldsVisual Fields
Indications, Diagnosis Codes, Frequency Indications, Diagnosis Codes, Frequency Medicare LCDMedicare LCD
Clinical judgment if no LCDClinical judgment if no LCD
4040
Visual FieldsVisual Fields
Indications, Diagnosis Codes, Frequency Indications, Diagnosis Codes, Frequency Non-Medicare Non-Medicare
Every plan has own rulesEvery plan has own rules
Clinical judgmentClinical judgment
May follow MedicareMay follow Medicare
4141
Visual FieldsVisual Fields
Unilateral / Bilateral Unilateral / Bilateral CPT: CPT: Unilateral or bilateralUnilateral or bilateral
Medicare: Medicare: Bilateral, Payment same whether Bilateral, Payment same whether test one or both eyestest one or both eyes
Non-Medicare: Non-Medicare: No universal rule, may follow No universal rule, may follow MedicareMedicare
4242
Visual FieldsVisual Fields
CCI CCI 92081 +92081 +
9208292082
9208392083
9921199211 (-59 ok)(-59 ok)
4343
Visual FieldsVisual Fields
CCI CCI 92082 +92082 +
9208192081
9208392083
9921199211 (-59 ok)(-59 ok)
4444
Visual FieldsVisual Fields
CCI CCI 92083 +92083 +
9208192081
9208292082
9921199211 (-59 ok)(-59 ok)
4545
Visual FieldsVisual Fields
Interpretation & ReportInterpretation & ReportYesYes
Doctor OrderDoctor OrderYesYes
Supervision LevelSupervision Level GeneralGeneral
4646
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
Scanning Imaging (GDx, OCT)Scanning Imaging (GDx, OCT)
PachymetryPachymetry
Visual FieldsVisual Fields
Fundus PhotoFundus Photo
Serial TonometrySerial Tonometry
GonioscopyGonioscopy
Extended OphthalmoscopyExtended Ophthalmoscopy
4747
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
9225092250 Fundus photographyFundus photography
(no mention of instrument sophistication)(no mention of instrument sophistication)
(no mention of angle or resolution)(no mention of angle or resolution)
4848
Fundus PhotoFundus Photo
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Medicare LCDMedicare LCD
Noridian: Noridian: RetiredRetired
CGS: CGS: YesYes
WPS:WPS: RetiredRetired
Novitas:Novitas: YesYes
Palmetto: Palmetto: YesYes
4949
Fundus PhotoFundus Photo
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Medicare LCDMedicare LCD
Clinical judgment if no LCDClinical judgment if no LCD
5050
Fundus PhotoFundus Photo
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Medicare LCDMedicare LCD
LCD example:LCD example: “ “Fundus photo may be used for Fundus photo may be used for diagnosisdiagnosis
of macular degeneration, retinal of macular degeneration, retinal neoplasms, choroid disturbances, diabetic neoplasms, choroid disturbances, diabetic retinopathy, glaucoma, multiple sclerosis, retinopathy, glaucoma, multiple sclerosis, central nervous system anomalies.” central nervous system anomalies.” (CGS (CGS 2013)2013)
5151
Fundus PhotoFundus Photo
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Medicare LCDMedicare LCD
LCD example:LCD example:
“ “to document a disease process, plan to document a disease process, plan its treatment, or follow progress of a its treatment, or follow progress of a disease”disease”
5252
Fundus PhotoFundus Photo
Indications, Diagnosis Codes, Frequency Indications, Diagnosis Codes, Frequency Medicare LCDMedicare LCD
LCD example: LCD example:
“ “not medically necessary simply to document not medically necessary simply to document existence of condition. Photographs may be existence of condition. Photographs may be medically necessary to establish baseline to medically necessary to establish baseline to judge later whether disease is progressive.”judge later whether disease is progressive.”
5353
Fundus PhotoFundus Photo
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Non-MedicareNon-Medicare
Every plan has own rulesEvery plan has own rules
Clinical judgmentClinical judgment
May follow MedicareMay follow Medicare
5454
Fundus PhotoFundus Photo
Unilateral / Bilateral Unilateral / Bilateral CPT: CPT: SilentSilent
Medicare: Medicare: Bilateral, Payment same whether one or Bilateral, Payment same whether one or both eyesboth eyes
Non-Medicare: Non-Medicare: No universal rule, may follow No universal rule, may follow MedicareMedicare
5555
Fundus PhotoFundus Photo
CCI CCI 92250 +92250 +
9213392133 (-59 ok)(-59 ok)
9213492134 (-59 ok)(-59 ok)
9921199211 (-59 ok)(-59 ok)
Note: EO is not on CCINote: EO is not on CCI
5656
Fundus PhotoFundus PhotoInterpretation and reportInterpretation and reportYesYes
Doctor OrderDoctor OrderYesYes
Supervision LevelSupervision LevelGeneralGeneral
5757
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
Special TestsSpecial Tests
Scanning Imaging (GDx, OCT)Scanning Imaging (GDx, OCT)
PachymetryPachymetry
Visual FieldsVisual Fields
Fundus PhotoFundus Photo
Serial TonometrySerial Tonometry
GonioscopyGonioscopy
Extended OphthalmoscopyExtended Ophthalmoscopy
5858
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
92100 92100 Serial tonometry (separate procedure) Serial tonometry (separate procedure)
with multiple measurements of IOP with multiple measurements of IOP over an extended time period, same over an extended time period, same day (eg,diurnal curve or medical day (eg,diurnal curve or medical treatment of acute elevation of treatment of acute elevation of intraocular pressure) intraocular pressure)
““MultipleMultiple”” = ? = ?
5959
Serial TonometrySerial Tonometry
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Medicare LCDMedicare LCD
Noridian: Noridian: NoNo
CGS: CGS: NoNo
WPS:WPS: NoNo
Novitas:Novitas: NoNo
Palmetto: Palmetto: NoNo
6060
Serial TonometrySerial Tonometry
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Medicare LCDMedicare LCD
Clinical judgment if no LCDClinical judgment if no LCD
6161
Serial TonometrySerial Tonometry
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Non-Medicare Non-Medicare
Every plan has own rulesEvery plan has own rules
Clinical judgmentClinical judgment
May follow MedicareMay follow Medicare
6262
Serial TonometrySerial Tonometry
Unilateral / Bilateral Unilateral / Bilateral CPT: CPT: Silent Silent
Medicare: Medicare: Bilateral, Payment is same Bilateral, Payment is same whether test one or both eyeswhether test one or both eyes
Non-Medicare: Non-Medicare: No universal rule, may No universal rule, may follow Medicarefollow Medicare
6363
Serial TonometrySerial Tonometry
CCI CCI 92100 +92100 +
9921199211 (-59 ok)(-59 ok)
6464
Serial TonometrySerial Tonometry
Interpretation & ReportInterpretation & ReportYesYes
Doctor OrderDoctor OrderNoNo
Supervision LevelSupervision LevelConcept does not applyConcept does not apply
6565
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
Special TestsSpecial Tests
Scanning Imaging (GDx, OCT)Scanning Imaging (GDx, OCT)
PachymetryPachymetry
Visual FieldsVisual Fields
Fundus PhotoFundus Photo
Serial TonometrySerial Tonometry
GonioscopyGonioscopy
Extended OphthalmoscopyExtended Ophthalmoscopy
6666
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
92020 Gonioscopy 92020 Gonioscopy (separate (separate procedure)procedure)
6767
GonioscopyGonioscopy
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Medicare LCDMedicare LCD
Noridian: Noridian: RetiredRetired
CGS: CGS: NoNo
WPS:WPS: NoNo
Novitas:Novitas: NoNo
Palmetto: Palmetto: NoNo
6868
GonioscopyGonioscopy
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Medicare LCDMedicare LCD
Clinical judgment if no LCDClinical judgment if no LCD
6969
GonioscopyGonioscopy
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Non-Medicare Non-Medicare
Every plan has own rulesEvery plan has own rules
Clinical judgmentClinical judgment
May follow MedicareMay follow Medicare
7070
GonioscopyGonioscopy
Unilateral / Bilateral Unilateral / Bilateral CPT: CPT: Silent Silent
Medicare: Medicare: Bilateral, Payment is same Bilateral, Payment is same whether test one or both eyeswhether test one or both eyes
Non-Medicare: Non-Medicare: No universal rule, may No universal rule, may follow Medicarefollow Medicare
7171
GonioscopyGonioscopy
CCI CCI 92020 +92020 +
9228592285 (-59 ok, add to 92020)(-59 ok, add to 92020)
9921199211 (-59 ok)(-59 ok)
7272
GonioscopyGonioscopy
Interpretation and reportInterpretation and reportNoNo
Doctor OrderDoctor OrderNoNo
Supervision LevelSupervision LevelConcept does not applyConcept does not apply
7373
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
Special TestsSpecial Tests
Scanning Imaging (GDx, OCT)Scanning Imaging (GDx, OCT)
PachymetryPachymetry
Visual FieldsVisual Fields
Fundus PhotoFundus Photo
Serial TonometrySerial Tonometry
GonioscopyGonioscopy
Extended OphthalmoscopyExtended Ophthalmoscopy
7474
Coding for Glaucoma & Coding for Glaucoma & Glaucoma Suspects Glaucoma Suspects
Ophthalmoscopy, extended, with retinal Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, drawing (eg, for retinal detachment, melanoma); melanoma);
9222922255 initial initial
922292226 6 subsequent subsequent
7575
Extended Extended OphthalmoscopyOphthalmoscopy
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Medicare LCDMedicare LCD
Noridian: Noridian: RetiredRetired
CGS: CGS: YesYes
WPS:WPS: RetiredRetired
Novitas:Novitas: YesYes
Palmetto: Palmetto: YesYes
7676
Extended Extended OphthalmoscopyOphthalmoscopy
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Medicare LCDMedicare LCD
Clinical judgment if no LCDClinical judgment if no LCD
7777
Extended Extended OphthalmoscopyOphthalmoscopy
LCD example:LCD example:- Initial Initial and periodicand periodic evaluation of evaluation of
serious internal eye disorders. serious internal eye disorders. - Generally covered for neoplasms, Generally covered for neoplasms,
retina disorders, retina disorders, glaucomaglaucoma, trauma, , trauma, vitreous disorders.vitreous disorders.
7878
Extended Extended OphthalmoscopyOphthalmoscopy
LCD example:LCD example:
- Stable conditions such as retinopathy in - Stable conditions such as retinopathy in stable diabetic may require only stable diabetic may require only annualannual study while acute intraocular infection study while acute intraocular infection may require may require weeklyweekly studies. studies.
7979
Extended Extended OphthalmoscopyOphthalmoscopy
Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Non-MedicareNon-Medicare
Every plan has own rulesEvery plan has own rules
Clinical judgmentClinical judgment
May follow MedicareMay follow Medicare
8080
Extended Extended OphthalmoscopyOphthalmoscopy
Unilateral / Bilateral Unilateral / Bilateral CPT: CPT: SilentSilent
Medicare: Medicare: Unilateral, Bill separate for each Unilateral, Bill separate for each eye, RT & LT modifiereye, RT & LT modifier
Non-Medicare: Non-Medicare: Typically unilateral Typically unilateral
8181
Extended Extended OphthalmoscopyOphthalmoscopy
CCI CCI 92225 +92225 +
9921199211 (-59 ok)(-59 ok)
92226 +92226 +
9921199211 (-59 ok)(-59 ok)
8282
Extended Extended OphthalmoscopyOphthalmoscopy
Interpretation and reportInterpretation and reportYesYes
Doctor OrderDoctor OrderNoNo
Supervision LevelSupervision LevelConcept does not applyConcept does not apply
8383
Extended Extended OphthalmoscopyOphthalmoscopy
Size & ColorSize & Color
--Palmetto: “minimum size of Palmetto: “minimum size of approximately 4 inches in diameter”approximately 4 inches in diameter”
-CGS: “minimal size of 3-4 inches”-CGS: “minimal size of 3-4 inches”
8484
AMDAMD
file://localhost/Users/alanhomestead/Documents/My Documents B 3-8-13/Adventures 11-3-12/O - S/Presentations/Repository of My PowerPoints/1 Topic Modules/AMD/AMD Aug 13.ppt
8585