Coding

Knowing Astigmatism Codes

Learn when and how to code for the diagnosis and correction of this conditions that affects nearly 1 in 3 Americans.

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

Corneal astigmatism affects about 35% of the cataract population and nearly 1 in 3 Americans. When astigmatism is small (less than 0.50 D) it may not require correction. When greater than this, best-corrected acuity may be affected.

Measurement

Refraction is most often coded by CPT code 92015, but it deals with most refractive errors, not just astigmatism. Other than Vision Plans or special coverage, it’s generally not covered by insurance and the patient usually pays for the service.

Keratometry is what we usually think of for anterior corneal astigmatism measurement with contact lenses and in IOL calculations. It is “incidental” to these services and is not separately billable.

Corneal Topography (CT) is denoted by CPT code 92025. It’s more than just central anterior curvature like keratometry; the entire corneal surface (anterior and posterior) may be mapped. You may see it listed in payer polices noted as “Computerized Corneal Topography.” There are many devices capable of performing CT—either alone, or in combination with other measurements. When done for irregular astigmatism (such as is found in keratoconus or pellucid marginal degeneration, for example) CT may be a covered service. Some payers also allow payment for CT under certain situations after corneal transplant surgery. It does require an interpretation and report; be sure there is an image to refer to as well. When done as corneal curvature for IOL calculations, it is not payable separately since it is then part of the IOL measurement and calculation. A few payers severely restrict the use of 92025; be sure to check.

Surgical coding

Surgery for astigmatism is usually done for refractive reasons and the patient is responsible for payment. When done in combination with cataract surgery, usually via limbal or corneal relaxing incisions (whether bladed or laser), no specific code exists. It is appropriate in this situation to use CPT code 66999, unlisted procedure, anterior segment of eye.

LASIK or PRK procedures (with or without astigmatism) are generally considered “cosmetic refractive surgery” in nearly all situations and are therefore patient-pay, although there may be contractual payment limits or “benefits” under some insurance plans. Coding is normally done via internal billing system codes or via Healthcare Procedure Coding System (HCPCS) codes S0800 (LASIK) or S0810 (PRK).

Although rare, CPT code 65771, Radial keratotomy, still exists. It most likely has coverage much like LASIK or PRK above. OP

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