CODING & REIMBURSEMENT

Testing: Color Vision

By Suzanne Corcoran

Color vision testing examines the ability to distinguish between colors, most commonly red/green but other combinations as well. Basic color vision testing, such as Ishihara plates, is part of an eye examination.

Ophthalmologists perform more extensive color vision testing for a variety of reasons, including suspicion of congenital or acquired color vision defects, vision-related optic nerve problems and monitoring high-risk medications such as Plaquenil (Hydroxychloroquine sulfate, Sanofi-Adventis). Now for what you need to know to obtain reimbursement.

Q What CPT code describes color vision testing?

A CPT 92283 (Color vision examination, extended, e.g., anomaloscope or equivalent) describes color vision testing that is more extensive and rigorous than is typically done during an eye exam. Among testing methods that support 92283, the more common are the Farnsworth D-15, Farnsworth-Munsell 100-Hue, and the Nagel anomaloscope.

Q Is color vision testing covered by Medicare and other payers?

A Sometimes. When a patient fails the basic color test, more extensive testing may be required. Coverage depends on the results of the extended testing and the doctor’s interpretation.

Q What does Medicare allow for extended color vision testing?

A CPT 92283 is per patient, not per eye. The 2013 national Medicare Physician Fee Schedule allowable is $57.50. Of this amount, $48.31 is for the technical component and $9.19 is for the professional component.

This test is subject to Medicare’s Multiple Procedure Payment Reduction (MPPR). This reduces the allowable for the technical component of the lesser-valued test when two or more tests are performed on the same day.

Q What is the frequency of extended color vision testing in the Medicare program?

A Extended color vision testing is rare within the Medicare program. For ophthalmology and optometry combined, it was reported less than one time per 10,000 eye exams.

Q What documentation is required to support this test?

A CMS requires a physician’s order and interpretation. An interpretation should discuss the results of the test and treatment (if any). A brief notation such as “abnormal” does not suffice.

In addition to the patient’s name and the date of the test, good documentation includes the following:

• Physician’s order – Extended color vision testing to rule out Plaquenil macula toxicity - patient unable to complete 10-2 HVF.

• Reliability of the test – Prompt responses.

• Findings – Some red-green defects noted OU.

• Assessment, diagnosis – Plaquenil macula toxicity OU; no prior hx of color vision defects.

• Impact on treatment, prognosis – Recommend discontinuing Plaquenil, letter to rheumatology.

• Physician’s signature – I.C. Better, MD.