Distinguish Between Optic Nerve And Retina Laser Scans

By Author: Angela Martin
Total Articles: 206
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Irritated by the the lack of specificity in scanning laser coding? Well, gear up for 2011 - the coming year's CPT manual will not only help you distinguish between anterior and posterior segment scanning, but also come up with just-in codes to distinguish between optic nerve and retinal scans.


Even though scanning laser ophthalmic diagnostic imaging (SCODI) is normally used as a diagnostic test for early detection of glaucoma, it's also a valuable tool for the evaluation and treatment of individuals with retinal disease, including individuals with diabetic retinopathy and macular degeneration. SCODI is able to feature the microscopic anatomy of the retina and the vitreo-retinal interface.


To differentiate between the two diagnostic purposes, CPT will do away with the old all-purpose posterior segment SCODI code, 92135 and replace it with these two just-in more specific codes: SCODI code, 92135, 92134.


For instance: An optometrist would report 92133 for "any glaucoma suspect, anyone that failed a vision field screening test like the FDT [frequency doubling technology], ...
... pale optic nerves, or any optic nerve defect like a colaboma.CPT 92134 would be for macular degeneration, cellophane maculopathy, or determining if a macular degeneration is wet or dry.


It should not be difficult to know when to report these new codes. Codes 92133 and 92134 just depict the difference between scanning the optic nerve versus the retina. It is not really all that difficult to discern between the two areas.


Give this new code for Anterior SCODI a shot


The new year also introduces a new Category I CPT code for anterior segment SCODI: 92132.


This permanent code does away with a temporary code introduced a couple of years ago. CPT introduced temporary Category III code 0187T in 2009. Anterior segment optical coherence tomography SCODI didn't fit under the existing posterior segment scanning code 92135. Anterior and posterior segment scans use different light wavelengths and require different machines.


Watch out for bilateral coding changes


An important phrase to keep your eye on in the descriptors of these just-in codes is 'unilateral or bilateral' - replacing the word 'unilateral' in the descriptor for 92135. This may signal a change in how Medicare will reimburse for SCODI carried out on both eyes in the coming year.


Presently, Medicare sees 92135 as inherently unilateral, assigning it modifier indicator "3" in the Physician Fee Schedule. If your optometrist carries out 92135 on both eyes in 2010, you can bill 92135 bilaterally and expect to be paid fully for both eyes.


But with their code descriptors specifying 'unilateral or bilateral', Medicare may require you to bill 92133 or 92134 only once, irrespective of whether the test is carried out on one or both eyes. Medicare hasn't set payment values and restrictions on these codes as yet.


Receive new remote imaging codes


If your practice is taking advantage of high-speed internet access to share diagnostic images with retinal specialists in remote places, in the coming year you can take the help of two all new codes: 92227, 92228.


A remote imaging system is capable of taking images of the retina with a wide-angle lens and transmitting them to a qualified retina specialist anywhere in the globe. Remember that these codes too are specified as 'unilateral or bilateral'.


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