Coding Tips for Common Ophthalmology Services: Part Two

Closeup of an Eye - ophthalmologyThis is the second blog in a two part series on common ophthalmology services and how to avoid billing errors. To reduce the risk of an audit and costly billing mistakes, here are some tips on common ophthalmology tests and procedures.

  • Fluorescein angiography. Use CPT code 92235, Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral. This test is used for evaluating retinal, choroidal, and iris blood vessels, as well as any eye problems affecting them. Fluorescein dye is injected into an arm vein, then rapid, sequential photographs are taken of the eye as the dye circulates. The cost of the dye is not separately payable and this code does not include fundus photos (CPT 92250). When medically necessary this test is payable during the global postoperative period whether related or unrelated to the surgery.
  • Fundus photography. Use CPT code 92250, Fundus photography with interpretation and report. Fundus photography is a process of using special optical imaging equipment to document the diagnosis and treatment of diseases of the eye. Fundus photography may be indicated to document abnormalities related to a disease process affecting the eye, or to follow the course of such disease. It also lends itself to the assessment of a wide variety of retinal disorders. Photography documenting external eye abnormalities may also be necessary. Payment for this test is bilateral. When medically necessary this test is payable during the global postoperative period whether related or unrelated to the surgery.
  • Excision of lesion. The CPT code to use depends on the size of the lesion: 68110 (excision of lesion, conjunctiva, up to 1cm), 68115 (excision of lesion, conjunctiva, over 1 cm), 68130 (excision of lesion, conjunctiva, with adjacent sclera). The criteria for modifier -25 must be met when billing an established patient office visit the same day that CPT code 68110 or 68115 is performed. Payment is per eye. A biopsy and excision of the same lesion are not payable on the same day. CPT codes 68110 or 68115 are appropriate for pinguecula excision based on size. For Medicare Part B patients, when surgery is performed bilaterally, submit one line item with the surgical code appended by modifier -50, with a 1 in the unit field and the charge doubled.
  • Trabeculoplasty. Use CPT code 65855, trabeculoplasty by laser surgery; also known as ALT or SLT. This laser surgery removes part of the trabecular meshwork to increase outflow of aqueous from the eye; a type of filtering surgery used in the treatment of glaucoma. Known as Argon laser trabeculoplasty (ALT), Micropulse laser trabeculoplasty (MLT), and Selective laser trabeculoplasty (SLT). Payment is per eye. The global period for Medicare patients is 10 days. The global period for non-Medicare patients is 90 days. Modifier -57 should be appended to the office visit when an ALT/SLT is performed the same day for a non-Medicare patient. Do not report 65855 with 65860, 65865, 65870, 65875, 65880.

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