Coding & Reimbursement

OCT Coding Fine Points

By Suzanne L. Corcoran, COE

Technology of diagnostic testing equipment continues to advance at a rapid pace. Today, many of the optical coherence tomography devices scan the anterior segment as well as the posterior segment, and as a result are inc reas ingly found in the offices of comprehensive ophthalmologists. Here are some of the questions that I typically receive on the topic.

Q. What are the indications for scanning computerized ophthalmic diagnostic imaging of the anterior segment (SCODI-A)?

A. There are many indications, including: assessment both of corneal flap thickness and residual stromal thickness following LASIK, measuring corneal thickness, visualization of IOLs and other implants in the anterior segment, evaluation of anterior segment ocular structures, measurement of anterior chamber angles, anterior chamber depth and anterior chamber diameter.

Q. What CPT code should we use to describe SCODI-A?

A. In 2010, use 0187T to report this test. This Category III CPT code is defined as: Scanning computerized ophthalmic diagnostic imaging, anterior segment with interpretation and report, unilateral. Do not use 92135 to report SCODI-A.

Q. Does Medicare cover SCODI-A, and what is the reimbursement?

A. SCODI-A is covered for evaluation of narrow angles and a few other disorders of the cornea, iris and ciliary body; check your local coverage policies for more information. Within the Medicare Physician Fee Schedule, Category III CPT codes are not assigned RVUs and do not have an allowable amount.

Payment is at the discretion of the Medicare administrative contractor. We hope to have a permanent code soon, which would allow assigned RVUs.

Q. What are the supervision rules?

A. There is no Medicare supervision policy published for SCODI-A. In our opinion, it seems reasonable to use general supervision since 92135 falls under that requirement.

General supervision means that 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. However, the physician's prompt interpretation of the test results is still required.

Q. If SCODI-A and SCODI of the posterior segment (92135) are performed on the same day for the same patient, can both be billed?

A. No. Although these are very different tests performed for different reasons and reported using different codes, Medicare's NCCI edits bundle 0187T with 92135. If both codes are billed, only 92135 will be paid.

Q. What documentation is required in the medical record to support claims for SCODI-A?

A. In addition to proof that digital images exist, the chart should contain:

• an order for the test with medical rationale
• date of the test
• reliability of the test
• test findings (e.g., dislocated IOL)
• a diagnosis (if possible)
• the impact on treatment and prognosis
• the signature of the physician

Q. May 92020 (gonioscopy) be used to report imaging of the anterior chamber angle?

A. No. Gonioscopy, as the term is commonly understood, does not include imaging. Rather, CPT 92285 (external ocular photography with interpretation and report for documentation of medical progress) is used to report goniophotography. Note that SCODI-A is not classified as photography but as computerized diagnostic imaging.

Q. May I use CPT code 76513 to identify SCODI-A?

A. No. CPT 76513 is used to describe anterior segment ultrasound. The devices currently on the market use optical technology rather than ultrasound, so 76513 is not appropriate.

Q. My device also performs pachymetry. May I use 76514?

A. No. CPT 76514 is used to describe pachymetry by ultrasound. The devices currently on the market use optical coherence tomography rather than ultrasound, so 76514 is not appropriate.

Q. If SCODI-A is performed for a non-covered indication, who is responsible?

A. The beneficiary is financially responsible for non-covered services. Explain to the patient why SCODI-A is necessary and that Medicare will likely deny the claim. Ask the patient to assume financial responsibility for the charge; get his/her signature on an Advance Beneficiary Notice of Noncoverage prior to performing the test. You may collect your fee from the patient at the time of service or wait for a Medicare denial. If both the patient and Medicare pay, promptly refund the patient or show why Medicare paid in error. OM

Suzanne L. Corcoran is vice president of Corcoran Consulting Group. She can be reached at (800) 399-6565 or www.corcoranccg.com.