icd 9 code for gonioscopy

What is the CPT code for gonioscopy?

Gonioscopy CPT Code Description 92018 Ophthalmologic examination and evaluatio ... 92019 Ophthalmologic examination and evaluatio ... 92020 Gonioscopy (separate procedure)

What are the indications for gonioscopy?

The indications for gonioscopy include, but are not limited to, glaucoma, hypotony, occlusive disorders, diabetic retinopathy, rubeosis, aphakia, an intraocular foreign body, and a subluxated or dislocated lens (Figure 1).

Is gonioscopy covered by Medicare?

Gonioscopy is defined by the Centers for Medicare & Medicaid Services as bilateral, so reimbursement is for both eyes. Unlike most other ophthalmic diagnostic tests, gonioscopy is not subdivided into a technical and a professional component, because no portion of the test can be delegated to a technician.

Is CPT code 92020 gonioscopy copyrighted?

Information provided by our coding experts is copyrighted by the American Academy of Ophthalmology and intended for individual practice use only. Question: We received a denial from a commercial payer on CPT code 92020 Gonioscopy.

How do you bill a gonioscopy?

To report this test, use CPT 92020, Gonioscopy (separate procedure). CMS defines 92020 as bilateral, so reimbursement is for both eyes.

Is gonioscopy part of routine eye exam?

Test Overview Gonioscopy is a painless examination to see whether the area where fluid drains out of your eye (called the drainage angle) is open or closed. It is often done during a regular eye examination, depending on your age and whether you are at high risk for glaucoma.

What gonioscopy means?

Listen to pronunciation. (GOH-nee-OS-koh-pee) A procedure in which a gonioscope (special lens) is used to look at the front part of the eye between the cornea (the clear layer) and the iris (the colored part of the eye). Gonioscopy checks for blockages in the area where fluid drains out of the eye.

What is direct gonioscopy?

Direct gonioscopy, as the term suggests, provides a straight-on view of the angle rather than the mirror image given by the indirect lenses. Direct gonioscopy permits the examiner to vary the angle of visualization more readily—to enable one to look over the curvature of iris bombé, for example.

How often can you bill for gonioscopy?

The AAO's Preferred Practice Patterns suggests that gonioscopy be repeated periodically and mentions every 1 to 5 years. Repeat testing is indicated when medically necessary for new symptoms, progressive disease, new findings, unreliable prior results, or a change in the treatment plan.

How do I report findings in gonioscopy?

When documenting your gonioscopy findings, draw a large X to designate the four quadrants. Record the most posterior structure youve observed in each quadrant, and record the abnormalities and amount of pigment. Also, use the van Herick system for grading angle depth.

What is indirect gonioscopy?

Indirect Gonioscopy A drop of topical anesthetic is then applied to the conjunctiva of both eyes. If using the Goldmann lens, contact gel is placed in the concave part of the lens. If using a Posner or similar type lens, a drop of artificial tears can be placed on the concave surface.

Is dilation required for gonioscopy?

For a gonioscopy exam, your eyes will be dilated with eye drops. This is done so that the ophthalmologist can fully examine the health of the optic nerve and retina. Once the pupils are dilated, you will rest your head in the chin holder of a slit-lamp microscope.

What is compression gonioscopy?

Pressure on the cornea by the goniolens (compression/indentation gonioscopy) can push the angle open and help determine the true angle configuration.

What does a gonioscopy look like?

2:004:32A brief guide to gonioscopy - YouTubeYouTubeStart of suggested clipEnd of suggested clipAnd you're looking for the beam from the side on and then what you see is basically brown iris andMoreAnd you're looking for the beam from the side on and then what you see is basically brown iris and then white sclera above it and sometimes you see some Brown lines.

Why is gonioscopy important?

The drainage angle is challenging to access, which is why gonioscopy is necessary. This test is especially helpful in detecting: Closed-angle glaucoma: Fluid isn't draining correctly because the angle is closed. Open-angle glaucoma: The anterior chamber angle is open, but fluid isn't draining as it should.

What are the indications for gonioscopy?

The indications for gonioscopy include, but are not limited to, glaucoma, hypotony, occlusive disorders, diabetic retinopathy, rubeosis, aphakia, an intraocular foreign body, and a subluxated or dislocated lens (Figure 1). The AAO's Preferred Practice Patterns discusses the usefulness of gonioscopy in glaucoma for "careful evaluation ...

How often should gonioscopy be repeated?

The AAO's Preferred Practice Patterns suggests that gonioscopy be repeated periodically and mentions every 1 to 5 years. Repeat testing is indicated when medically necessary for new symptoms, progressive disease, new findings, unreliable prior results, or a change in the treatment plan.

Is gonioscopy a technical test?

Unlike most other ophthalmic diagnostic tests, gonioscopy is not subdivided into a technical and a professional component, because no portion of the test can be delegated to a technician. The 2008 national Medicare Physician Fee Schedule allowable is $23.99. This amount is adjusted in each area by local wage indices.

Is gonioscopy underutilized?

Gonioscopy continues to be an important diagnostic tool for the ophthalmologist and optometrist, but it appears to be underutilized based on the prevalence of glaucoma and the frequency of paid claims for this test for Medicare beneficiaries. We encourage you to reconsider your usage of this test and your billing patterns for it.

What is the ICD-9 code for glaucoma?

Code: 92004 new OR 92014 established. Perform this on every glaucoma (ICD-9 365.11) or glaucoma suspect (365.01) patient at least once each year. When coding for the exam, you basically have two options: evaluation and management (E/M) codes and eye codes. In the vast majority of patients, we usually go with the ophthalmology codes (920XX) because it's easier to meet the documentation requirements, particularly the history components.

What is the CPT code for a corneal pachymeter?

Code: 76514. With the release of the Ocular Hypertension Treatment Study, the corneal pachymeter has become part of the standard of care for any optometrist managing glaucoma. Effective Jan. 1, 2004, Medicare assigned a regular CPT code: 76514, ophthalmic ultrasound, echography, diagnostic; corneal pachymetry, unilateral or bilateral. This is something that should be done on every glaucoma and glaucoma suspect patient. You can perform the measurement of corneal thickness as often as you feel necessary; however, most insurances will reimburse it for only once in an individual's lifetime.

What is IOP measurement?

IOP measurement. The measurement of IOP is an essential part of diagnosing and managing the glaucoma or glaucoma suspect patient. When done as part of a comprehensive or intermediate eye exam, it's considered an incidental component of an eye exam with no additional reimbursement.

What is the code for a visual field evaluation?

Code: 92083 . Visual field evaluation has been a vital aspect of the diagnosis and management of glaucoma and is the most common auxiliary test doctors order for glaucoma patients. Although many new methods have been developed to assess visual function in glaucoma and glaucoma suspect patients, perimetric evaluation of the glaucomatous visual field remains a cornerstone in the protocol. In terms of coding, three levels of visual field testing exist: 92081 , 92082 and 92083. The last digit depends on the number of isopters in the test. In virtually all glaucoma and glaucoma suspect patients, you'll bill the 92083 code for a full threshold visual field examination.

What are the factors that determine a glaucoma test reimbursement?

In general, proper reimbursement for testing performed on glaucoma or glaucoma suspect patients depends on the following four factors: 1. Proper coverage for the service. 2. Proper justification for the service. 3. Proper documentation of the service. 4. Proper coding on the claim form (CPT and ICD-9).

What is the code for anterior chamber angle?

Code: 92020. Visual examination of the anterior chamber angle is a valuable tool for the proper diagnosis and management of glaucoma. The initial evaluation of any newly diagnosed glaucoma or glaucoma suspect patient is complete only if it includes gonioscopic examination. Not only that, but proper long-term management of glaucoma requires gonioscopy at appropriate intervals because the configuration of the angle can change over time.

What is the code for a stereo photo of the optic nerve head structure?

Code: 92235. Stereo photography of the optic nerve head structure is the minimum standard of care for any glaucoma patient. This photography can take place in the form of actual photographs, which are kept in the patient chart or digital images stored on a computer. If the digital images are stored on a disc or a place separate from the patient's chart, you should document the place of that storage in the medical records as well as include a separate sheet where you record the photographic interpretation report that explains what you have documented in the photographs and what decisions and planning that you are basing on it.

What is the CPT code for goniotomy?

While many CPT codes are bundled with the 65820 goniotomy code (see “CCI Bundling”), it is worth making a mental note of the 7 codes below, all of which can be unbundled when appropriate.

What does GATT stand for in gonioscopy?

What does gonioscopy-assist­ed transluminal trabeculot ­omy (GATT) using a suture or iTrack microcatheter (Ellex) have in common with procedures that use the Kahook Dual Blade (New World Medical), Trab360 (Sight Sciences), or Trabectome (NeoMedix)? Per the Acad­emy Health Policy Committee, these ab interno trabeculotomy (also known as goniotomy) techniques can be billed using CPT code 65820.

What is a CCI code?

The Correct Coding Initiative (CCI) lists pairs of codes—known as bundled codes or CCI edits—that should not be billed separately when services are performed by the same physician on the same eye on the same day.

Can you code a goniotomy for open angle glaucoma?

Keep in mind the following: Goniotomy should not be coded in addition to other angle surgeries or canal implants. Goniotomy treats congenital glauco­ma and adult open-angle glaucomas. If using an ophthalmic endoscope, you can bill 66990 as well as 65820. Payment is per eye.