Coding & Reimbursement

Testing for Tear Osmolarity?

How to obtain reimbursement for this dry eye diagnostic

By Suzanne L. Corcoran, COE

Increasing recognition of dry eye disease means increasing use of laboratory tests to diagnose it. Here’s what you’ll need to know to obtain reimbursement for these treatments.

Q What is tear osmolarity testing? When is it indicated?

A Tear osmolarity testing objectively measures the concentration of dissolved solutes in tear aqueous. A concentrated tear film is hyperosmotic, due to aqueous evaporation, which places stress on the corneal epithelium and conjunctiva. Elevated osmolarity can cause less regulation of the tear film, more damage to the ocular surface and more inflammation. Research suggests hyperosmolarity is a primary indicator of tear film integrity.

Osmolarity testing is indicated to aid in the diagnosis of dry eye disease in patients suspected of having the disease. Because multiple kinds of dry eye exist, osmolarity testing can help the physician differentiate between them and plan an appropriate treatments. For instance, low tear volume is managed differently than poor tear quality.

Q May staff perform osmolarity testing?

A A medical assistant or ophthalmic technician may perform this test under supervision of an ophthalmologist or optometrist.

Q How should we document osmolarity testing in the patient’s medical record?

A As with other diagnostic tests, a well-documented chart note for osmolarity testing includes:

• An order for the test with medical rationale.
• Date of test.
• Test findings.
• Diagnosis (if possible).
• Impact on treatment and prognosis
• Signature of the physician and date.

Q Is this test covered by Medicare and other third-party payers?

A Yes, when testing is medically necessary and ordered by a licensed provider, tear osmolarity is covered and reimbursed as a laboratory service by a federal Clinical Laboratory Improvement Amendments Act (CLIA)-waived entity. While Medicare coverage is universal, other third-party payer policies vary. Check with local payers for specific coverage and payment policies.

Q How do we bill for tear osmolarity testing?

A Use CPT 83861 (mcrofluidic analysis utilizing an integrated collection and analysis device, tear osmolarity) to report this service on claims for reimbursement. This code is “per eye”. When testing both eyes, use 83861-RT and 83861-LT, or follow specific payer instructions. The 2013 Medicare Laboratory Fee Schedule allowed amount is $22.71 per eye. Laboratory services are not subject to local wage indices — the rate is the same for all providers throughout the country. Under Medicare, co-payment and deductible amounts do not apply to lab services.

The code is paid under the Medicare laboratory fee schedule. Medicare requires modifier -QW to indicate that your location is registered as a CLIA-waived entity. The CLIA certificate number is reported in box 23 of the CMS-1500 claim form.

Q What are CLIA regulations and why are they important?

A In-vitro testing is regulated by the CLIA. Tear osmolarity testing falls under this regulation, because human specimens are collected and analyzed. An objective of the CLIA is to ensure the accuracy, reliability and timeliness of test results regardless of where the test was performed.

Q What must I do to comply with CLIA?

A You must register each physician office with the CLIA program and obtain a CLIA waiver certificate. Some states (e.g., Nevada, New York) limit or restrict optometrists from serving as CLIA laboratory directors.

Q Why and when would you retest tear osmolarity?

A Diagnostic testing is warranted by the physician’s need for information that cannot be obtained by an eye exam alone. Re-testing is reimbursed when medically necessary for covered indications. Re-evaluation of a chronic condition associated with new symptoms, disease progression, a revision of the treatment plan, or addition of a new comorbidity, supports another eye examination, and may support re-testing of tear osmolarity. Re-testing is not a substitute for an eye exam and is not associated with every exam of patients with dry eye. OM

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