Coding and Reimbursement
Coding for Visual Fields
How to ensure reimbursement -- and avoid charges of fraud.

BY SUZANNE L. CORCORAN, COE

When submitting claims for visual field testing, you have three CPT coding options:

• 92081: visual field examination, unilateral or bilateral, with interpretation and report; limited examination (e.g., tangent screen, or single stimulus level automated test)
• 92082: visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (e.g., at least 2 isopters on Gold- mann, or automated suprathreshold)
• 92083: visual field examination, unilateral or bilateral, with interpretation and report; extended examination (e.g., Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30°, or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey VF analyzer full threshold programs 30-2, 24-2, or 30/60-2).

Note: Testing one eye today and the fellow eye a week later to elicit more reimbursement would be fragmentation, and could be considered fraud.

Q: What are the indications for visual field testing? Visual field tests should be used to detect and monitor changes in the patient's peripheral vision resulting from trauma, glaucoma, visual pathway disorders (such as lesions or tumors), optic nerve conditions, and so forth. In general, this is covered "when medically indicated." However, clear documentation of the reason for testing is always required.

Most Medicare carriers have published policies with acceptable diagnosis codes. Glaucoma suspect (365.00) is covered in all published policies.

Sometimes you may feel that a visual field is merited even though the indications don't match Medicare's list. In these situations, Medicare may not reimburse you. The patient should sign an advance beneficiary notice prior to testing so that you can bill him if Medicare refuses to pay. (Medicare may also refuse to reimburse if you test a patient more often than is customary.)

Q: How often may the test be performed? According to most published Medicare policies, one field per year is warranted for borderline or controlled glaucoma, two fields per year are warranted for uncontrolled glaucoma, and three fields are warranted for unusual cases such as patients with only one eye.

Q: What documentation is required to support a claim for a visual field? In addition to the visual field printout, the medical record should contain:

• an order for the test
• the date of the test
• the reliability of the test (was the patient cooperative?)
• an interpretation of the results, with report
• impact on treatment and prognosis
• your signature.

Visual fields now require only general supervision, so you don't have to be in the office when the test is performed.

Q: What are reimbursement amounts for this test? In 2002, the national Medicare fee schedule includes $80.36 for 92081, $47.42 for 92082, and $73.48 for 92083. These amounts are adjusted by local wage indices in each area. (We believe the higher reimbursement for the limited test is an error that will probably be corrected.) Don't bill for a tangent screen when you do a full threshold test; deliberately billing for something not done is considered fraud.

Q: Can we be paid for visual fields with an office visit or other tests? According to the National Correct Coding Initiative (NCCI), visual field codes aren't bundled with any other code, but they are mutually exclusive. For example, if you performed a 92082 and, based on the results, decided to perform a 92083, you'd bill only for the test with the higher value (92083).

Note: Many Medicare local policies don't cover scanning laser ophthalmoscopy (92135) on the same day as a visual field.

Suzanne L. Corcoran, COE, is vice president of Corcoran Consulting Group. She can be reached at (800)399-6565 or via e-mail at scorcoran@corcoranccg.com.