Coding and Reimbursement
Optical Coherence Biometry
An expert explains what you need to know to ensure proper reimbursement when using this new technology.

BY SUZANNE L. CORCORAN, COE

Q: What is optical coherence biometry?

Optical coherence biometry (OCB) is a new technology developed by Zeiss Humphrey that allows surgeons to measure the eye in preparation for cataract surgery and IOL implantation. The first instrument to use this technology is Zeiss Humphrey's IOLMaster.

The IOLMaster uses partially coherent light to measure the axial length of the eye along its visual axis; it also provides the surgeon with keratometry (K) readings and anterior chamber depth measurements. These measurements are used by the on-board computer system to calculate an appropriate IOL power, in diopters.

Measuring the eye with the IOLMaster takes less time than using ultrasound, and it can be accomplished without the technician having to touch the patient's eye.

Q: How do we get reimbursed for performing this test?

CPT includes a new code for OCB, effective January 1, 2002: 92136 (ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation).

Prior to 2002, there was no established CPT code for OCB; surgeons commonly used 92499 (unlisted ophthalmic service) for this test. Optical coherence biometry doesn't use ultrasound technology, so a diagnostic ultrasound procedure code wouldn't apply.

Because unlisted codes don't have established values, reimbursement was sometimes a problem. Also, some third-party payers were slow to accept this test and establish payment policies without a formal code. Now that a specific CPT code exists, both of these situations should improve.

Other OCB coding considerations include:

Unilateral or bilateral. CPT doesn't specify whether optical coherence biometry is a unilateral or bilateral test, but Medicare's 2002 Physician Fee Schedule defines the service as bilateral. Therefore, one payment will be made for both eyes.

Private insurers set their own policies in this area, but they often follow Medicare's lead.

Amount of reimbursement. The Medicare national allowable amount for OCB in 2002 is $77.10. That amount is adjusted in each area using local wage indices.

Coverage criteria. No national policy currently addresses coverage criteria for use of this technology, but most Medicare carriers have published local policies regarding this test.

Like A-scan biometry, surgeons most frequently use OCB for the diagnosis and management of cataract. Covered diagnoses for A-scan biometry fall in the ranges of 366.00 to 366.9 and 743.30 to 743.39, and similar coverage rules apply to OCB.

Documentation. Like all diagnostic tests, certain documentation is required in the medical record to support your claims for OCB. Documentation must include:

• the patient's name and the date of service
• indications for testing (this is usually met by documenting the plan for cataract surgery)
• the order for OCB (this will be part of the physician's plan at the end of the exam)
• results of the test
• doctor's signature
• interpretation of the test.

The IOLMaster produces a printout that becomes part of the permanent medical record. In this context, the interpretation of the test is the IOL power selected based on the measurements.

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