Coding

Coding for visual field level

Use this guide to determine which VF code is most appropriate.

By Paul M. Larson, MBA, MMSc, COMT, COE, CPC, CPMA

Visual fields (VF) are one of the most common diagnostic tests. We perform these tests for glaucoma, optic nerve disease, and functional loss from eyelids and brows, among other reasons.

This column concentrates on which of the code options are appropriate based on the type of VF ordered and done.

Three levels

The 2014 edition of Current Procedural Terminology (CPT) lists three levels.

An order is also required; no order means the test is not billable. The order can be given on a prior visit or during a visit on the same day as the test. Billing before the VF interpretation is completed is not proper. Only the clinician has the legal basis to determine the diagnosis.

Unilateral or bilateral

The code descriptor “unilateral or bilateral” means the same code is used if performed on one or both eyes. It is the rare payer who requires a -52 modifier to denote a reduced service when only one eye is done (some also want a box 19 comment on the CMS-1500 claim form or electronic equivalent).

Most common code

The most common code among Medicare beneficiaries is 92083. Manual perimetry is an option here if three or more isopters are plotted and static checking is done within the central 30 degrees, but that’s uncommon nowadays. More frequently, this is a fully-computerized VF with monitoring during the test by the technician. The program performed and completed is important; if two tests are done, only a single code is normally billable per patient per day. The descriptor states it must be a quantitative threshold-based program; without this, a lower level code must be chosen. CPT does not restrict 92083 to full-threshold mode testing so fast-thresholding algorithms are acceptable. Swedish Interactive Threshold Algorithm (SITA) standard and SITA fast are also acceptable — even if done via blue-yellow, or Short Wavelength Automated Perimetry (SWAP).

Least common code

92082 is the least common test for Medicare beneficiaries. It also has a manual option (two isopters only, or three or more, but without the static central checking). The automated, computerized testing options are for semi-automated, suprathreshold and screening strategies. The binocular Esterman test and some full-field screening tests are examples of 92082.

Lowest level code

92081 is the lowest level of visual field test. Any test not meeting 92082 or 92083 falls at this level. While not usual in a glaucoma-based practice, it is quite common in oculoplastics to note the deficit caused by lids and brows. CPT Assistant, the companion to CPT, in September 2010 published that this is the appropriate level for lid surgery even though “two” (taped and untaped) of the same isopter is plotted. They also noted that 92081 is not billable twice in this instance. Occasionally, payers will allow code 92082 (or 92081 twice) in this scenario, but they are rare and you should verify it beforehand.

Determination of VF levels

Determination of VF level is not hard, but it does require knowledge of the testing strategy employed during the test, and if manually performed, you need to know the number of isopters among other factors. OP

Mr. Larson is a senior consultant at Corcoran Consulting Group. He specializes in coding and reimbursement. Mr. Larson is based in Atlanta.