Coding & Reimbursement

A rare test for glaucoma needn’t be provocative

By Suzanne L. Corcoran

These glaucoma tests are rare, but questions still arise. In case you have some, here’s help.

Q. What is provocative testing for glaucoma?

A. These diagnostic tests attempt to deliberately elevate IOP. There are two types: tests that increase aqueous humor in patients with open-angle glaucoma (OAG), and tests that induce pupillary blockage in patients with narrow angles or angle-closure glaucoma (ACG).

• OAG - Ibopamine provocative test^1,2

• OAG - Water-drinking provocative test (WDT)^3-5

• ACG, OAG - Ocular hypertension induced by topical steroid^4,6

• ACG - Dark room test⁷

• ACG - Mydriasis provocative test with 1% cyclopentolate

• ACG - Pilocarpine phenylephrine provocative test (PPPT)⁸

• ACG - Prone test

Q. Who performs these tests?

A. An ophthalmologist, optometrist or other qualified health-care professional. Evaluation and management of glaucoma are the province of ophthalmologists and some optometrists. The tests should not be performed by someone who is not trained, staffed and equipped to cope with the consequences of elevated IOP or angle closure.

Q. How do we code for this?

A. Use CPT code 92140 - Provocative tests for glaucoma, with interpretation and report, without tonography, for this test in any form. Also, your claim for reimbursement will include an appropriate ICD-10 code in the H40- series.

Q. What does Medicare allow for 92140?

A. In 2016, the national Medicare Physician Fee Schedule-allowed amount is $64. As always, this amount is adjusted by local indices, so actual payment will vary. Other payers have their own fee schedules.

Q. What documentation is required in the medical record to support claims for glaucoma provocative testing?

A. A physician’s interpretation and report are required — a brief notation such as “abnormal” does not suffice. In addition to the images, the medical record should include:

• Order for the test with medical rationale

• Date of the test

• The reliability of the test (e.g., test completed)

• Test findings (e.g., IOP rose from 19/20 at start to 28/26 at completion)

• Comparison with prior tests (if applicable)

• A diagnosis (if possible)

• The impact on treatment and prognosis (e.g., significant variation in IOP; new anti-glaucoma drop required)

• Physician’s signature

Q. How frequently is this test performed?

A. In clinical practice today, provocative glaucoma testing is rarely used. In 2014, Medicare paid for 29.2 million eye exams, but only 13,000 provocative tests for glaucoma. OM

REFERENCES

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