Clinical Scorecard: Coding Strategy Coding for Glaucoma

At a Glance

Key Highlights

• Medicare and many insurers discourage multiple diagnostic/management tools on the same day due to NCCI edits.
• New CPT code 92137 for OCT-A of the retina cannot be billed with other OCT codes 92133/92134.
• Proper documentation and correct CPT/ICD-10 coding are essential to withstand audits and receive reimbursement.

Guideline-Based Recommendations

Diagnosis

• Use appropriate CPT codes for diagnostic tests such as gonioscopy (92020) and ultrasound pachymetry (76514).
• Avoid billing for OCT angle scan or OCT pachymetry when not reimbursed by insurers.

Management

• Document clinical findings and management plans clearly in patient charts to justify testing and treatment.
• Continue monitoring patients with visual field testing and intraocular pressure checks as clinically indicated.

Monitoring & Follow-up

• Schedule follow-up visual field and IOP checks every six months or as clinically appropriate.
• Document stability or progression of glaucomatous optic neuropathy to support ongoing care.

Risks

• Interchanging CPT codes for different diagnostic tests can lead to audit failures.
• Billing multiple imaging modalities on the same day without justification may be denied due to NCCI edits.

Patient & Prescribing Data

Glaucoma patients undergoing diagnostic evaluation and management

Maintaining IOP-lowering treatment and regular monitoring is critical; documentation supports treatment continuity and reimbursement.

Clinical Best Practices

• Understand and apply correct CPT and ICD-10 codes specific to glaucoma diagnostic and management procedures.
• Maintain thorough and specific documentation in patient records to justify testing and treatment decisions.
• Avoid billing multiple overlapping diagnostic tests on the same day unless clinically justified and allowed by payors.

References

• American Academy of Ophthalmology Coding and Reimbursement
• Medicare National Correct Coding Initiative (NCCI) Edits