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Scanning laser glaucoma test
A practice wishing to perform more screening on patients without glaucoma must follow the specific billing guidelines.
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A practice has purchased a new piece of scanning laser equipment (GDx) that is designed to help in the early detection of glaucoma. In the past, the practice always billed for a visual field and fundus photos. Now that it is using the new GDx, the practice seems to be performing the test on every patient who has a family history of glaucoma, not simply on its established glaucoma patients. In addition, a question arises whether the practice should be billing this procedure as a “per eye” or as a unilateral service.
What are the guidelines for billing the GDx or HRT to Medicare?
The scanning laser test (eg, GDx, HRT, etc) allows for earlier detection of glaucoma damage to the nerve fiber layer or optic nerve of the eye. It is the goal of these glaucoma diagnostic tests to discriminate among patients with normal IOPs who have glaucoma, patients with elevated IOP who have glaucoma and patients with elevated IOP who do not have glaucoma. This allows early treatment of the disease, preventing unnecessary medical or surgical therapy.
Most carriers have published specific billing guidelines for code 92135 that generally include the following protocols:
The scanning laser glaucoma test is used once a year to follow pre-glaucoma patients (elevated IOP, but no signs of glaucoma) or those with “mild damage to the nerve fiber layer.”
Patients with “moderate damage” may be followed with both scanning laser glaucoma test and visual fields. One or two of each test per year may be appropriate.
In “advanced damage,” visual field testing would be preferred instead of scanning laser glaucoma tests. Most carriers believe that it is rarely necessary to perform more than four visual fields in a year in “advanced damage,” and that scanning laser glaucoma tests are rarely necessary or beneficial.
Code 92135 is billable as a unilateral service (ie, per eye). In addition, a physician’s order must be recorded in the chart, and a separate interpretation and report must be included. The printout of the scanning laser results usually has a “comments” section that can be used to document the report by the physician.
Most carriers will deny the following procedures if performed on the same day as the scanning laser, unless medical necessity for the additional tests is clearly noted in the chart: fundus photos (92250); extended ophthalmoscopy (92225 and 92226); and B-scan (76512).
Physicians should always check their Medicare newsletters for specific billing guidelines.