Coding & Reimbursement

Medicare Reimbursement for Testing With the Visante OCT

By Suzanne L. Corcoran, COE

New diagnostic equipment continues to be embraced by the eyecare community. Coding for new diagnostic tests also continues to be a challenge. I'll explain the challenges encountered for the Visante OCT (Carl Zeiss Meditec, Jena, Germany).

Q. What is the Visante OCT and what are its indications?

A. The Visante OCT is a scanning computerized diagnostic imaging (SCODI) device. Prior to its introduction, all SCODI devices were used to evaluate the posterior segment. The Visante OCT uses non-contact optical coherence tomography (OCT) to study the anterior chamber and related structures.

Indications for testing with the Visante OCT include: assessing both corneal flap thickness and residual stromal thickness following LASIK, measuring corneal thickness, visualizing IOLs and other anterior segment implants, and measuring anterior chamber angles, anterior chamber depth and anterior chamber diameter.

Q. What CPT code describes this test?

A. Effective Jan. 1, 2008, use CPT code 0187T to describe this test. This new Category III code is defined as scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral. With the introduction of a Category III code, it is no longer appropriate to use 92135.

Although the Visante OCT measures anterior chamber angles, it is not gonioscopy because CPT 92020 does not include imaging. Likewise, goniophotography would be described using CPT code 92285; OCT is not classified as photography, but as computerized diagnostic imaging. Some have asked whether Visante OCT might be coded as 76513, but that describes anterior segment ultrasound and Visante OCT uses optical coherence tomography.

Finally, although the Visante OCT measures corneal thickness, CPT 76514 is not appropriate because it describes pachymetry using ultrasound rather than optical coherence tomography.

Q. Does Medicare cover testing with the Visante OCT?

A. Possibly, but it will be done on a case-by-case basis. Currently, no payment policies have been published. All existing policies for OCT describe indications that include glaucoma and several other posterior segment disorders, and contemplate high-resolution imaging of some or all of the posterior segment.

The Medicare Physician Fee Schedule does not include RVUs or values for Category III codes. If Medicare does cover the test, payment is at the discretion of the Medicare administrative contractor and it is likely that payments will vary.

Just as there is no payment policy, there are — as yet — no supervision rules for anterior segment SCODI. It seems reasonable to use general supervision since other OCT testing falls under that requirement. General supervision means the procedure is furnished under the physician's overall direction and control, but the physician's presence is not required during the performance of the procedure.

Q. What documentation is required in the chart?

A. Documentation requirements are similar to other ophthalmic diagnostic tests. In addition to proof that the digital images exist, the chart should contain:

• An order for the test with medical rationale
• The date of the test
• The reliability of the test
• Test findings
• A diagnosis, if possible
• The impact on treatment and prognosis
• The physician's signature.

Remember that Medicare covers diagnostic tests when they are medically necessary. In the absence of a physician's interpretation, a Medicare review would very likely decide that the test was not medically necessary if the physician cared so little about it that he did not bother to review the results and document an interpretation.

Q. May we bill for the Visante OCT and posterior segment SCODI on the same day?

A. Yes. These are very different tests, performed with different instruments, for different reasons. They are coded using different CPT codes. OM