Coding & Reimbursement

Billing & Multiple-Test Devices

By Suzanne L. Corcoran, COE

Some diagnostic testing devices may perform more than one test. Questions arise as to whether these tests may all be billed. Here is the advice practices typically request.

Q. Is it possible to bill for more than one test on the same day using one device?

A. Yes. Multiple tests may occur on the same day, and be billed, as long as there is sufficient justification for each service and the services are not duplicative, bundled or mutually exclusive. For instance, assessing different parts of the eye using different tests is one justification, as occurs when corneal topography is performed at the same time as scanning computerized ophthalmic diagnostic imaging of the anterior segment (SCODI-A). Additionally, patients may have several comorbidities that warrant investigation using different tests, such as cataract, narrow angles and corneal ectasia.

Obvious duplication occurs when the same digital image of the eye is billed twice. For example, we do not advocate billing external photography and SCODI-A concurrently because an individual digital slice from SCODI-A imaging would qualify for external photography. Choose one or the other in this situation.

As an example, the Pentacam (manufactured and distributed by Oculus, Inc.) performs many different tests with multiple CPT codes.

• External ocular photography (CPT 92285)
• Corneal topography (CPT 92025)
• Optical corneal pachymetry (Unlisted test, 92499)
• Optical tomography of the anterior segment (SCODI-A, CPT 92132)

Other tests performed with the Pentacam are not separately billed. Some of these tests include densitometry and keratometry, which are treated as incidental components of an eye exam.

Q. Does Medicare cover external photography and corneal topography?

A. Medicare covers diagnostic tests, such as external photography, if the patient presents with a complaint that leads you to perform this service or as an adjunct to management and treatment of a known disease. If the images are taken as baseline documentation of a healthy eye or as preventative medicine to screen for potential disease, then they are not covered.

Also, external photography is not covered if performed for an indication that is not cited in the local coverage determination.

Many Medicare administrative contractors have published policies for corneal topography with broad coverage indications including corneal diseases, injuries and complications of surgery. As with all diagnostic tests, repeat testing frequency is based on medical necessity for each individual patient.

Q. Does Medicare cover billing for SCODI-A?

A. Yes, to a limited degree. In 2011, CPT 92132 replaced 0187T to report SCODI-A. Only a few policies exist and they only include indications for narrow anterior chamber angles and iris abnormalities.

Q. What about corneal pachymetry?

A. Corneal pachymetry is covered for two distinctly different reasons:

(1) Corneal disease.

(2) Ocular hypertension and glaucoma. For glaucoma and ocular hypertension, Medicare usually only covers corneal pachymetry once per lifetime. However, repeat pachymetry associated with corneal pathology such as keratoconus, endothelial cell disease and keratoplasty is covered based on medical necessity.

CPT has a code for corneal pachymetry: 76514 (Ophthalmic ultrasound, echography, diagnostic; corneal pachymetry, unilateral or bilateral, determination of corneal thickness).

Both optical and ultrasonic pachymeters are available; 76514, because it is a radiological code, only describes pachymetry by ultrasound. When optical corneal pachymetry is performed, use CPT 92499 (unlisted ophthalmological service or procedure).

Q. How frequently may diagnostic tests be performed?

A. Some reasons for repeated testing include:

• During the eye exam that precedes the order for another test, the physician has formed a suspicion that the patient's condition has changed for the worse due to:

– objective evidence of vision loss
– new symptoms or complaints
– a recent surgical intervention
– exam findings of disease progression

• The results of an earlier test are no longer considered reliable.
• The AAO's Preferred Practice Patterns recommend repeat testing at specific intervals. OM

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