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2. Getting Paid for Technology
Harvey Richman, OD
Rebecca Wartman, OD

3. Disclaimers for Presentation
All information was current at time it was prepared
Drawn from national policies, with links included in the presentation for your use
Prepared as a tool to assist doctors and staff and is not intended to grant rights or impose obligations
Prepared and presented carefully to ensure the information is accurate, current and relevant
No conflicts of interest exist for presenters- financial or otherwise. However, both Rebecca and Harvey write for Optometric Journals and Rebecca consults with Eye Care Centers OD PA.

4. Disclaimers for Presentation
Of course the ultimate responsibility for the correct submission of claims and compliance with provider contracts lies with the provider of services
AOA, Heart of America, its presenters, agents, and staff make no representation, warranty, or guarantee that this presentation and/or its contents are error-free and will bear no responsibility or liability for the results or consequences of the information contained herein
The content of the COPE Accredited CE activity was prepared with assistance from AOA Staff and Doug Morrow OD

5. Disclaimers for Presentation

6. Cornea and Anterior Segment

7. Topography
92025
Computerized corneal topography, unilateral or bilateral with interpretation and report
Detection of subtle corneal surface irregularity and astigmatism
Computerized corneal topography, unilateral or bilateral, is also known as computer assisted keratography or videokeratography. This is a method of measuring the curvature of the cornea. A special instrument projects rings of light onto the eye, which are reflected back to the device, which then creates a color-coded map of the cornea's surface with a cross-sectional profile. Defects such as scarring, astigmatism, and other abnormal curvatures of the eye can be detected using this method, which is commonly performed prior to corrective eye surgery, such as LASIK.

8. Elevation maps Various overlay and fit zone options

9. Indications & Limitations of Coverage:
Post penetrating keratoplasty
Post kerato-refractive complications
Post op irregular astigmatism
Corneal dystrophy, bullous keratopathy
Complications of transplanted cornea
Keratoconus
Reasons for Denial
Non-covered for refractive procedures
Billable privately or included in exam fee for contact lens evaluations

10. Compare corneal with total WF
Corneal wavefront allows direct comparison of corneal and ocular wavefronts
Compare corneal with total WF

11. Corneal Wavefront Analysis
Currently, no separate code for Corneal Wavefront Analysis
Cannot use Corneal Topography for this
92499 possible but miscellaneous service often not covered and often require special report with claim
Consider using ABN to collect from patient

12. Collagen Cross-Linking
0402T
Collagen cross-linking of cornea
(including removal of the corneal epithelium and intraoperative pachymetry when performed)

13. Corneal Hysteresis 92145 Corneal hysteresis determination,
by air impulse stimulation,
unilateral or bilateral,
with interpretation and report
No utilization guidelines or published LCDs
National Non-facility Medicare Fee $17.66
Cornea’s ability to absorb and dissipate energy

14. Low Corneal Hysteresis
Optic nerve damage
Visual field loss
Functional progression of GLC
Larger magnitude of IOP reduction
Dynamic finding may increase with medications

15. 0198T
Measurement of ocular blood flow by repetitive intraocular pressure sampling, with interpretation and report
Often not paid current since Category III
Consider using an ABN

16. 92286
Anterior segment imaging with interpretation and report; with specular microscopy and endothelial cell analysis
Bilateral code
Medicare National Non-facility Fee: $39.64

17. 92286 Justified
Slit lamp evidence of endothelial dystrophy (guttata) & corneal edema
Undergoing secondary intraocular lens implant
Previous ocular surgery now requires cataract surgery
Fitting with extended wear contact after ocular surgery
Limitations-
Not eligible if only visual problem is cataract considered part of presurgical examination.
Preoperative evaluation of refractive keratoplasty not covered

18. Corneal Confocal Microscopy

19. Corneal Confocal Microscopy
Examines unmyelinated corneal nerve high magnification, using laser-scanning CCM to image corneal sub- basal nerve plexus
Can predict insipient peripheral neuropathy in Type 1 DM
(63% Sensitive; 74% Specific)
Reduced Corneal NFL length & Corneal sensitivity =
increased severity diabetic peripheral neuropathy
Previous studies demonstrate utility for CCM in other neuropathies
No Code Miscellaneous with ABN
Not included in 92286
published online January 8, 2015 in Diabetes Care by Nicola Pritchard, of Queensland University of Technology, Australia, and colleagues.

20. Blepharoplasty Guidelines
Visual fields sometimes used determine medical necessity
Often performed with taped lids then untapped lids Repeated service should be submitted with CPT modifier 76 on a separate detail line
2 fields often denied
External Photos now often used
Review carrier LCD

21. New Blepharoplasty Guidelines
CGS: Complaint - Physical findings - Visual fields
Noridan: Complaint - Physical finding - Photos
WPS: Complaint - Physical findings - Visual fields – Photos
Palmetto: Complaint - Physical findings - Photos
4 Carriers with LCD for Blepharoplasty
2 have eliminated Visual Fields requirement

22. 92285 (For meibomian gland imaging, use 0507T)
External ocular photography with interpretation and report for documentation of medical progress (eg, close- up photography, slit lamp photography, goniophotography, stereo-photography)
(For tear film imaging, use 0330T)
(For meibomian gland imaging, use 0507T)
Medicare Fees National Non-Facility Fee $21.98
Bilateral

23. External Ocular Photography 92285
Check carrier for limitations or restrictions of coverage
External ocular photography is covered when special camera is used to obtain magnified photographs of lesions (e.g., the cornea, iris or lids) for purpose of monitoring and following the patient's condition
Medical quality images may be of digital, Polaroid Macro 3 SLR or equivalent
Photographs for purpose of documenting for medicolegal purposes or preauthorization (e.g., gross trauma, amount of ptosis or redundant lid tissue) are not separately reimbursed - not medically necessary

24. MGD Dysfunction
Lipiflow

25. Ocular Surface Interferomoter
MGD Imaging
Lipiscan

26. CPT III CODES
0330T
Tear film imaging, unilateral or bilateral, with interpretation and report
0207T
Evacuation of meibomian glands, automated, using heatand intermittent pressure, unilateral

27. 0507T
Near infrared dual imaging (ie, simultaneous reflective and transilluminated light) of meibomian glands, unilateral or bilateral, with interpretation and report
Again, CPT III codes typically not covered without specific carrier guidance
Consider using an ABN

28. 0514T Intraoperative visual axis identification using patient fixation
(List separately in addition to code for primary procedure)
(Use 0514T in conjunction with 66982, )

29. Lens Autofluorescence
Measurements of autofluorescence, collected using a Lens Fluorescence Biomicroscope calibrated with standards traceable to National Institute of Standards and Technology (NIST), detected type 2 diabetes with a sensitivity of 67% and a specificity of 94%. By comparison, the hemoglobin A1C test demonstrated detection with a sensitivity of 44% and a specificity of 79%, and a fasting plasma glucose test demonstrated a sensitivity of 50% and a specificity of 95%.
"A lens autofluorescence test takes six seconds, is non-invasive and does not require fasting. Furthermore, standard blood tests require blood draw and assay materials, and creates biohazard waste," added Dr. John Burd, Chief Science Officer at Freedom Meditech. "A lens autofluorescence test may benefit individuals with an aversion to blood draw and those that do not frequently visit their primary physician. We see great opportunities for growth within eye care, integrated delivery networks and corporate health and wellness programs where the patient populations are enriched for undiagnosed diabetes."
Autofluorescence detects the presence of advanced glycation products, or AGEs, in the lens of the eye. AGEs are yellow-brown and fluorescent proteins that are modified when sugars are metabolized. In the crystalline lens of the eye, AGEs are long-lived and accumulate over time. Studies have shown that AGEs are correlated with uncontrolled glucose.

30. Lens Autofluorescence
Integral to General Ophthalmologic or E&M Now
No LCD/ Medical Policy Guidance
92499 could be considered but not recommended

31. Gonioscopy
92020
Used to diagnose injury or disease in anterior chamber of eye, performed under local anesthetic due to necessity of placing specialized lens directly on the eye to obtain a clear image
Bilateral Procedure Code
Medicare National Non-facility Fee: $28.11
Utilization as medically necessary

32. Anterior OCT

33. 92132
Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral
NOT GONIOSCOPY
National Medicare Non-facilty Fee $32.07

34. Pupilometry CPT 0341T RVU=0 (Local Carrier Priced)
Quantitative pupillometry with interpretation and report, unilateral or bilateral
RVU=0 (Local Carrier Priced)
Consider using an ABN

35. Pupilometry

36. June

37. Visual Field Examinations
92081 Limited, unilateral or bilateral, with interpretation and report; examination
92082 Intermediate, unilateral or bilateral, with interpretation and report
92083 Extended, unilateral or bilateral, with interpretation and report

38. Indications & Limitations of Coverage
Necessary to establish diagnosis
Monitor course for treatment
Determine change in therapeutic plan
medically necessary to diagnose and follow retinal disorders
92083 diagnosis or follow-up of glaucoma or neurologic disease

39. Visual Field Coding Guidelines
All services are considered bilateral
-50 modifier not appropriate
-52 modifier if can only doing one eye
-76 modifier if doing repeat procedure

40. Visual Field Technology
Visual field assessment, with concurrent real time data analysis and accessible data storage with patient initiated data transmitted to a remote surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional

41. Scanning Laser Tests
Confocal laser scanning ophthalmoscopy (topography)
Optical Coherence tomography

42. Versatile Multi-Modality Imaging
Glaucoma

43. Coding guidelines
92133: Scanning computerized ophthalmic diagnostic imaging (e.g., scanning laser) with interpretation and report, unilateral or bilateral: optic nerve
92134: Scanning computerized ophthalmic diagnostic imaging (e.g., scanning laser) with interpretation and report, unilateral or bilateral: retina
Do not use with -52, LT or RT modifier if reduced service
Not covered with SCODI:
92227, 92250
59 modifier usage (and CMS -59 alternatives)
CAUTION: GA modifier usage with ABN

44. Glaucoma Severity/Staging Level Scanning Laser Frequency
Current frequency limitations for Scanning Laser for many regions:
Mild or Suspect Glaucoma 1 Time per year
Moderate Glaucoma 2 Times per year
Advanced or Severe Glaucoma NO Scanning laser but up to Visual Fields / year
Read your LCD’s and other payer guidance!

45. 92133 Utilization Guidelines-GLC
Although CMS guidelines state
Only two exams/eye/year are allowed for patient who has or is suspected of having glaucoma
Most LCD state once per year to follow pre-glaucoma patients or those with “mild” stage
One or two tests per year for patients with “moderate staging,”
followed with SLT or visual fields
if both SLT and visual fields are used, only one of each tests
“Advanced stage” field testing preferred by Medicare guidance

46. 92134 Utilization Guidelines-AMD/DR
Only one exam/eye/2 months is allowed for the patient whose primary ophthalmological diagnosis is related to a retinal disease
One exam/eye/month is allowed for the patient who is undergoing active treatment for macular degeneration or diabetic retinopathy
Glaucoma?

47. Ganglion Cell Analysis: Use 92134 Isolates Ganglion Cell Layer
Measures thickness for sum of GCL and IPL layers using data from Macular cube scans.
RNFL distribution in the macula depends on individual anatomy, while the GCL+IPL appears regular and elliptical for most normal individuals
Excludes RNFL
Propriety algorithms are adapted for specific anatomy, use GCL and IPL thickness

48. Visual Evoked Potential - VEP
UPDATE 2018
Visual evoked potential (VEP) checkerboard or flash testing, central nervous system except glaucoma, with interpretation and report
Bilateral Code
General Supervision
Special Training?
Utilization Guidelines
Carrier Dependent

49. 0464T
Visual Evoked Potential, testing for glaucoma, with interpretation and report May NOT use any other VEP code with glaucoma diagnosis
NEW CODE

50. 0333T Acuity Screening Only
Visual evoked potential, screening of visual acuity, automated, with report
(For visual evoked potential testing for glaucoma, use 0464T)

51. Retinal Imaging CPT III Code
Computer-aided animation + analysis of time series retinal images for the monitoring of disease progression, unilateral or bilateral, with interpretation and report

52. Fundus Autofluorescence (FAF)

53. Fundus Autofluorescence (FAF)
Potential info health & function of entire retina
Photoreceptors contain light-sensing molecules susceptible to damage/x-linking, & shed their damaged outer segments
RPE phagocytize the segments & molecules stored in liposomes, forming lipofuscin (LF)
Disease states & oxidative damage =  LF
Hyper-fluorescence = excess LF accumulation
Hypo-fluorescence = RPE cells die/are absent
With the introduction of fluorescein angiography decades ago, ophthalmologists observed that, even without the use of fluorescein, parts of the fundus showed areas of fluorescence in certain conditions. Although this faint, so-called autofluorescence was at first considered to be a distraction, it was later found to have potential as a diagnostic indicator and a tool for monitoring disease progression. New instrumentation and techniques have been developed to begin harnessing its potential.1
We now know that fundus autofluorescence (FAF) imaging can provide information about the health and function not just of the central retina but in the periphery as well.
The Fluorescent Fundus
What causes fundus autofluorescence? The retinal photoreceptors contain light-sensing molecules, a class of retinoids that are susceptible to damage and cross-linking, said Richard F. Spaide, MD, in private practice with Vitreous-Retina-Macula Consultants of New York. The photoreceptors shed their damaged outer segments, which the retinal pigment epithelium (RPE) ingests through phagocytosis. The molecules are stored in liposomes and form lipofuscin (LF).1
Accumulation of lipofuscin. “Over years, each RPE cell will eventually phagocytize 3,000,000,000 outer segments, and up to 25 percent of the cell volume will be occupied by lipofuscin,” said Dr. Spaide. In addition to age, disease states and potentially increased oxidative damage can contribute to the buildup of LF in RPE cells.
LF can be made to fluoresce by a fairly broad range of wavelengths, about 500 to 800 nm.1 “After excitation, the molecule will spontaneously release a photon of light of a somewhat longer wavelength, efficiently recorded with a variety of imaging methods,” said Dr. Spaide.
Hyper- and hypofluorescence. Areas of excess LF accumulation will appear hyperfluorescent. But when RPE cells die or are absent, LF disappears, leading to hypofluorescence.
Not just the RPE. Fluorescence comes from other layers of the retina as well. “With age and under certain pathologic conditions, this autofluorescence increases dramatically and adds to the signal produced by the lipofuscin in the RPE,” said Dr. Spaide. 
Fundamentals of FAF
Two main methods are used to record autofluorescence: confocal scanning laser ophthalmoscopy (cSLO) and standard fundus camera photography, said Szilárd Kiss, MD, director of clinical research and assistant professor of ophthalmology at Weill Cornell Medical College in New York City.  
cSLO systems. The first method developed for clinical FAF imaging, cSLO uses a laser to rapidly and precisely scan the retina, said SriniVas Sadda, MD, associate professor of ophthalmology at the University of Southern California and the Doheny Eye Center in Los Angeles. Among the cSLO systems equipped for FAF imaging are the Heidelberg Retina Angiograph, which uses blue light, and the Optos OCT
SLO, which uses green light.
You can acquire images at nearly a video rate and add them together, Dr. Sadda said, which improves the signal-to-noise ratio and provides higher-quality images. “More important, you’re able to image structures that may be relatively weak in terms of their autofluorescence.”
Because light is forced through the confocal pinhole, this method allows you to selectively isolate a signal from one plane only. “This method has the advantage of rejecting spurious fluorescence from other structures in the eye, such as the lens, which has many fluorophores and fluoresces in the same wavelengths as lipofuscin,” said Dr. Spaide.
However, because only one plane can be seen, he added, conditions that increase fluorescence from the neurosensory retina, including almost any condition causing a serous or tractional detachment, will not be detected well with a cSLO-based system.
Fundus camera. In contrast, “The fundus camera shows a summation of fluorescence from the fundus and consequently can image fluorescence from the retina and RPE at the same time,” said Dr. Spaide. “The signal strength is sufficiently powerful so that only one photograph needs to be taken, instead of averaging images over time.”
Based on modifications pioneered by Dr. Spaide, the fundus camera FAF-imaging method uses filters exciting in the green spectrum and recording emission in the yellow-orange spectrum, said Dr. Sadda.
Does color matter? Noting that some systems use blue and others green light for excitation, Dr. Kiss said, “These provide essentially corresponding information about the retina. However, the green spectrum may provide some additional detail in the fovea, as the blue light tends to be absorbed by the high concentration of xanthophyll pigments.” Dr. Sadda added, “One advantage of longer-wavelength [green] light is that there is less absorption by the crystalline lens of the eye, which is quite autofluorescent with blue light, especially in patients with cataracts.”
Near-infrared. Light outside of the visible spectrum can also be used. “Near-infrared FAF imaging uses very long wavelengths of light—about 790 nm—just beyond the ability of the human eye to detect,” said Dr. Sadda. These wavelengths excite molecules other than LF, most notably, melanin. The distribution of melanin in the eye, he said, provides a different type of information about the disease process than LF alone.
Wide-field imaging. FAF imaging can be used to view only the posterior pole or all the way out to the periphery of the retina. For the latter, “You need a wide-field imaging platform such as the Optos system, which has the capability of scanning to 200 degrees,” said Dr. Kiss. The Optos uses an ellipsoidal mirror in the image pathway, said Dr. Spaide, which deflects light across a wide field of the ocular fundus.
In a retrospective review, Dr. Kiss and colleagues found peripheral autofluorescent abnormalities in nearly 64 percent of eyes in patients with age-related macular degeneration (AMD), compared with about 36 percent of control eyes, suggesting potential implications for diagnosing and treating different subtypes of the disease.2 A retrospective analysis by Dr. Sadda found similar abnormal peripheral patterns in a majority of patients with a wide range of diseases.3
Because the Optos scans such a large area of the retina, however, it cannot capture images quite as rapidly as the Heidelberg, said Dr. Sadda. It is also less confocal, which may create some “noise” in the image due to autofluorescence from other structures. 
Which Conditions to Test?
Unlike other imaging modalities, said Dr. Kiss, FAF provides functional information about retinal cells. According to Dr. Spaide, it is useful for almost any fundus disorder, including AMD, retinal detachment, inherited dystrophies, central serous chorioretinopathy, vitelliform lesions, and acute zonal occult outer retinopathy (AZOOR). Dr. Kiss noted that FAF is also helpful in screening for medication toxicity, including eye problems related to hydroxychloroquine (Plaquenil).
AMD. FAF imaging allows functional evaluation of geographic atrophy in dry AMD, said Dr. Kiss, making it possible to assess emerging therapies and monitor response to medication as well as progression of the disease. 
“Areas of geographic atrophy are hypofluorescent because there are no photoreceptors and no lipofuscin within the RPE cells,” he said. However, hyperfluorescence shows up in junctional zones around geographic atrophy where the RPE is working overtime—a foreshadowing of imminent atrophy.
“Of the studies using autofluorescence as a secondary end point, the most prominent one is AREDS 2,” said Dr. Kiss. The results may have a strong effect on the application of FAF imaging in the future, he added, just as OCT now influences clinicians’ treatment of patients with wet AMD.
Retinal detachment. Hyperfluorescence in areas immediately adjacent to a retinal detachment can demarcate its extent and help explain visual problems in patients, said Dr. Kiss. “In a small series using ultra-wide-field FAF imaging, we also showed that these areas can remain abnormal, even after the retina is reattached.”
Dystrophies and degenerations. Retinal dystrophies and degenerations also show abnormal autofluorescence, said Dr. Kiss. As with dry AMD, retinal dystrophies such as retinitis pigmentosa demonstrate areas of both hyper- and hypofluorescence, a sign that the retina is burning out.
“Always test Best disease,” said Dr. Kiss, “which is characterized by macular or submacular accumulation of lipofuscin material and has a sharp, characteristic hyperfluorescent region in the macula.” Dr. Spaide added, “We are familiar with Best disease causing a yellow egg yolk–like lesion in kids and young adults, but with time that will go away. However, FAF imaging shows widespread abnormalities in the fundus and also can find areas of atrophy within the lesions.”4
Dr. Sadda finds FAF particularly useful in diagnosing Stargardt disease, in which pisciform lesions are readily apparent.
Central serous chorioretinopathy (CSC). According to Dr. Spaide, the extent of CSC is best seen with autofluorescence, not just in the area of the subretinal fluid but also in other parts of the macula or even the other eye.
As with diseases that cause a buildup of vitelliform material, said Dr. Spaide, CSC accumulates outer segments that have been shed but not yet phagocytized. “In central serous chorioretinopathy, it is common to see subretinal accumulation of material,” he said. “Some ophthalmologists will call that ‘subretinal protein’ without giving the material much thought. However, it is highly autofluorescent in the wavelengths used to excite retinoids. Proteins do not efficiently autofluoresce in these wavelengths, so the hypothesis that the material is protein does not fit the available facts.”

54. LASER Speckle Flowgraphy
Noninvasive way to assess ocular blood flow
CRVO study completed
Medscape  (10/3, Haelle) reported, “Laser speckle flowgraphy may offer a noninvasive method of assessing ocular blood flow in patients with central retinal vein occlusion (CRVO),” suggests a 45-patient study  published in the October issue of the journal Retina.

55. Angiography software-OCTA
Non-invasive, dyeless
Hi-resolution, 3-D visualization of retinal vasculature
Images motion of scattering particles such as RBCs using sequential OCT x-sectional scans
Angiovue™ OCTA system, introduced at the September 2014 ESCRS congress in London, is a non-invasive and dyeless technique for evaluating physiologic components of the retina providing high resolution visualization of the vascular structure in three dimensions.
Angiovue allows clinicians to image the motion of scattering particles such as erythrocytes (red blood cells) using sequential OCT cross-sectional scans which are repeated at the same location on the retina. Capturing the dynamic motion of the erythrocytes (red blood cells) allows a 3D visualization of the perfused vasculature and micro vasculature of the retina. Unlike other imaging methods which utilize contrast agents, Angiovue allows visualization of vasculature within specific layers of the retina, without the blurring or obscuring effects of staining or pooling.
The unique combination of five important components:
Fast spectral-domain OCT (70,000 A-scans/sec),
Patented Motion Correction Technology (MCT),
Patented Split Spectrum Amplitude Decorrelation Angiography (SSADA),
CUDA parallel processing architecture,
Patented enface visualization of 3D OCT data,
…make OCT Angiography a clinical reality.
Offering OCT Angiography scanning of 3mm x 3mm, 6mm x 6mm and 8mm x 8mm of the retina, and 3mm x 3mm or 4.5mm x 4.5mm of the optic disc, the analysis reports present side-by-side OCT angiography and OCT structure (enface) results derived from the same data. Enface OCTA images of the superficial capillary plexus, deep capillary plexus, outer retina and choriocapillaris area can be displayed for assessment and adjusted by the clinician for optimal viewing of desired area within the 3D volume.
*Angiovue is not approved for sale in the U.S.

56. Wide Field Retinal Screening

57. S9986 or 92499 S9986: Not Medically Necessary Service
Patient is aware not medically necessary
92499: Unlisted ophthalmological service or procedure
Screenings are not covered in most cases
Consider using ABN

58. Macular Pigment Densitometers
92081

59. Macular Pigment Densitometers
Macular pigment optical density measurement by heterochromatic flicker photometry, unilateral or bilateral, with interpretation and report
NEW CODE

60. Preferential Hyperacuity Perimeter
Detection and characterization of central and paracentral metamorphopsia in patients with AMD
Discontinued 92082?
92499?
Consider an ABN
ForeSee PHP

61. 0469T
Retinal polarization scan, ocular screening with on- site automated results, bilateral
Retinal Birefringence scanners (RBS)
Hand held instruments
Measure the changes in the polarization of light
Detect eye misalignment or strabismus
No LCD
Medical Policy E/I/U

62. 92275-ERG DELETED Electroretinography with interpretation and report
Bilateral Code
LCDs Changing
Most TPP experimental except for plaquenil
Not for EOMs

63. Electoretinography
Electroretinography (ERG) is used to evaluate function of the retina and optic nerve of the eye, including photoreceptors and ganglion cells.
A number of techniques that target different areas of the eye, including,, and pattern (0509T) for retinal ganglion cells are used.
Multiple additional terms and techniques are used to describe various types of ERG
If the technique used is not specifically named in the code descriptors for , 92274, 0509T, use the unlisted procedure code

64. 92273 (new 2019)
Electroretinography (ERG), with interpretation and report ; full field (ie, ffERG, flash ERG, Ganzfeld ERG)
Full field (flash and flicker) (92273) for a global response of photoreceptors of the retina

65. 92274 (new 2019)
Electroretinography (ERG) with interpretation and Report; multifocal (mfERG)
Multifocal (92274) for photoreceptors in multiple separate locations in the retina, including the macula

66. 0509T (new 2019)
Electroretinography (ERG) with interpretation and report, pattern (PERG)

67. 92250:Fundus Photography Bilateral Code
Fundus photography with interpretation and report
Bilateral Code

68. Photography Document abnormalities
Check carrier’s medical policy for limitations or restrictions of coverage
Obtain filing requirements from carrier for bilateral or multiple procedures

69. 92250 Utilization Guidelines
Some carriers state it is not medically necessary to repeat fundus photography more often than every 2 years for follow-up of stable glaucoma.
Repeat photographs for retinopathy are rarely necessary.

70. Fundus Photography & SCODI
Continued confusion on billing photography and SCODI on same date of service
They are “mutually exclusive” as defined by current NCCI
Mutually exclusive is defined as “procedures that cannot reasonably be performed at the same anatomic site or same encounter.”

71. Fundus Photography & SCODI
There has been no specific document defining when you can use and with 92250
This means there is no official CMS guidance on using “mutually exclusive” codes on the same date of service.

72. National Correct Coding Initiative (NCCI)
Developed with RBRVS- 2003
Insures proper Medicare payments
(Resource Based Relative Value System)
Identify pairs of services not billed together
(same physician for same patient on same day)
Component element edits
92012 and 92014
Medically Unlikely Edits (MUE) policy manual
92133 or and but MAY use -59 modifier
92133 and may NOT be used together even with -59 modifier

73. NCCI Edits MUE together, column 1 code is paid
MUE MAY be allow together
0 not allowed
1 allowed
9 non-applicable
If clinical circumstances justify appending a modifier to column 2 code of code pair, payment for both codes may be allowed
MUST READ AND UNDERSTAND WHAT CAN BE DONE TOGETHER AND WHEN
Cannot use a modifier just to get paid

74. NCCI Edits Relevant to Optometry
Fundus photography (CPT code 92250) and scanning ophthalmic computerized diagnostic imaging (e.g., CPT codes 92132, , 92134) are generally mutually exclusive of one another in that a provider would use one technique or the other to evaluate fundal disease. However, there are a limited number of clinical conditions where both techniques are medically reasonable and necessary on the ipsilateral eye. In these situations, both CPT codes may be reported appending modifier 59 to CPT code (CPT code was deleted January 1, 2011.)

75. Modifier 59 New CMS Guidance
Treatment of posterior segment structures in the eye constitutes treatment of a single anatomic site. (See example 5-Modifier 59)
Modifier 59 should not be used if both procedures are performed during the same operative session because the retina and choroid are contiguous structures of the same organ

76. YOU SURVIVED

77. Questions? Thank You!