Rapid technological advances are changing the way optometrists deliver clinical care in a big way. Earlier, more than accurate diagnoses, ameliorate monitoring of chronic atmospheric condition and practice building opportunities are all not bad reasons to invest in new applied science. Only choosing which technology will help you deliver better care while maintaining a good for you bottom line is rarely like shooting fish in a barrel. Allow'south focus on Oct as an example.

OCT has been a mainstream role of optometric practice for nigh a decade. Some would even contend that is has become the standard of intendance for glaucoma and macular disease. Not surprisingly, in 2012, CMS updated the coding for October from a unmarried lawmaking (92135) to iii to further refine and define OCT usage:

  • 92132 : Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and study, unilateral or bilateral
  • 92133 : Scanning computerized ophthalmic diagnostic imaging, posterior segment, with estimation and written report, unilateral or bilateral; optic nerve
  • 92134 : Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina

While these codes describe typical OCT functionality, other capabilities oftentimes built into the device require a better understanding of the coding rules and regulations. The three I hear about virtually often are:

1. Screening Examination

If your October has a specific screening mode, you may be able to use it to provide a non-medically necessary screening of the retina. Coding for this screening procedure would be defined as S9986 - Not Medically Necessary Service (patient is aware that service non medically necessary). Being a Level Two HCPCS code, no reimbursement is typically associated with this code.

If your October doesn't accept a screening fashion, you and your specific OCT manufacturer must discover a clinically valid method for performing a procedure less detailed and invasive than a regular Oct. You cannot perform a full October capture, eliminate the interpretation and report and call it a screening.

2. Corneal Thickness and Contact Lens Fits

OCTs are already clinically indicated for the measurement of the angles or the crystalline lens, only many can also measure corneal thickness and help with contact lens fittings. While OCT may do a smashing job in measuring corneal thickness, the browse cannot exist coded as corneal pachymetry, CPT 76514, which is divers every bit "ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (conclusion of corneal thickness)." Instead, you must utilize CPT lawmaking 92132, for which in that location is generally no diagnosis that would support the procedure; you lot may besides discover that 92132 is often considered not-covered as experimental and investigational past many insurance carriers.

If you utilise your Oct for plumbing fixtures a contact lens, you are also obligated to use CPT lawmaking 92132.

3. OCT-angiography

If your OCT tin perform angiography, you may be tempted to code for and nib the added angiography component separately as CPT code 92499 (unlisted ophthalmological procedure). Nevertheless, non just is this inappropriate, just it's also against the CPT definition and interpretation. Instead, CPT code 92134 alone incorporates the angiography component in its base of operations definition of the code, and no additional code is necessary. In fact, coding with both CPT 92499 and CPT 92134 represents a coding and billing error. If paid for both, you would be obligated to return the 92499 payment to the carrier, or to the patient if they paid the extra. An ABN is non appropriate to use, equally information technology cannot be used to split a single service into two parts for the purpose of collecting boosted payment from the patient.

With technology swamping the field of optometry, we must carefully evaluate which tools are worth incorporating into our practices—and knowing both the opportunities for better clinical care and the limitations of the coding definitions and rules is the key.

Transport your coding questions to rocodingconnection@gmail.com .