Coding & Reimbursement

Corneal Topography Coding Pointers

By Suzanne L. Corcoran, COE

Issues about when it is appropriate to bill insurers for corneal topography vs. billing the patient continue to bedevil a lot of my clients. Here are some of the questions I commonly receive, as well as their solutions.

Q. What is corneal topography?

A. Corneal topography is a non-invasive medical imaging technique for mapping the surface curvature of the cornea. While keratometry provides a measure of corneal curvature with special attention to asphericity and astigmatism, corneal topography provides the eyecare professional with a precise map in minute detail of the configuration of the corneal surface.

Corneal topography is most frequently used for the diagnosis and management of corneal disease, disorders, abnormalities or injury. Commonly covered diagnoses include irregular astigmatism (367.22), keratoconus (371.60) and complication of corneal graft (996.51). Check your local coverage determination (LCD) policy for additional indications.

Corneal topography is identified by CPT code 92025, "Computerized corneal topography, unilateral or bilateral, with interpretation and report." CPT 92025 was effective Jan. 1, 2007; prior to that time, an unlisted code (92499) was used.

Q. Does Medicare cover corneal topography?

A. Sometimes: Medicare covers diagnostic tests that are medically necessary according to Medicare guidelines. When performed for one of the diagnoses noted above, there should be no problem with coverage. For other corneal conditions, you may explain that there is a chance of non-coverage and ask the patient to sign an Advance Beneficiary Notice (ABN) and submit your claim with modifier GA.

Prior to cataract surgery, claims will be considered by Medicare administrative contractors if there is a diagnosis, in addition to cataract, supporting medical necessity. More often, testing with corneal topography prior to cataract surgery is associated with planning for concurrent limbal relaxing incisions; thus, it is not covered.

Refractive surgery for the purpose of reducing dependence on eyeglasses or contact lenses is not covered by Medicare, nor are the diagnostic tests associated with this surgery, such as corneal topography. The patient is financially responsible for the service, either as a discrete charge or as part of the refractive surgery package. Inform the patient of his/her financial responsibility and get a signed Notice of Exclusion from Medicare Benefits (NEMB). If the Medicare beneficiary requests that a claim be filed, append modifier GY to the CPT code to indicate an excluded service.

Q. Is corneal topography bundled with other services?

A. Corneal topography is not bundled by Medicare with either eye exams or other tests. Additionally, according to CPT instructions, corneal topography is not to be reported in conjunction with corneal transplant (65710-54755). Other payers may, of course, have different rules.

Q. What documentation is required in the medical record to support charges for corneal topography?

A. The chart should contain:

► an order for the test with medical rationale

► the date of the test

► the reliability of the test

► the test findings (e.g., printout of corneal map)

► a diagnosis (if possible)

► the impact on treatment and prognosis

► the signature of the physician.

Q. What about supervision?

A. There is no supervision policy published for this diagnostic test. In our opinion, it seems reasonable to use general supervision since most non-invasive ophthalmic tests come 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 is Medicare's reimbursement for corneal topography?

A. CPT 92025 is defined as "unilateral or bilateral" so reimbursement is usually for both eyes. The 2008 national Medicare Physician Fee Schedule allowable is $31.23. Of this amount, $14.47 is assigned to the technical component and the remaining $16.76 is the value of the professional component (i.e., interpretation). These amounts are adjusted in each area by local wage indices. Other payers set their own rates, which may differ significantly from the Medicare published fee schedule. OM