Healthcare Fraud Shield’s Latest Article: Don’t lose sight of these eye testing schemes!

18 Apr

Glaucoma is the leading cause of blindness and can affect anyone from infants to elderly people.   Most people experience little to no symptoms and do not become aware of the problem until the loss is advanced.  Periodic eye exams are suggested to maintain eye health.  The National Institutes of Health (NIH), National Eye Institute states: “From 2000 to 2010, the number of people in the U.S. with glaucoma rose 23 percent from 2.22 million to 2.72 million.   Furthermore from 2010 to 2050, the number of people in the U.S. with glaucoma is expected to increase by more than double, from 2.7 million to 6.3 million.”[i]

What is the scheme?

Intraocular pressure (IOP) can be elevated in Glaucoma requiring testing called tonometry which measures the internal pressure in the eye.  A less common test is serial tonometry (CPT Code 92100) which is when IOP is measured at least three separate times during a single day.  This test is most commonly used in patients who have suspected normal tension glaucoma which the eye pressure is found to be in “normal range” requiring more extensive testing to identify any hidden pressure spikes.  AMA in Medicine, 92100 (Q&A) (June 1998). CPT® Assistant,[ii] provides some guidance on the expectations for the performance of this test and states: “When reporting code 92100, the intent is for three or more measurements of intraocular pressure to be performed. Serial tonometry is performed to monitor pressure over a long period of time to look for a time of day rhythm (that is, a number of measurements separated by many hours).”   

Single surveillance tonometry is considered a bundled component of an eye examination and is not billable separately.  In the scheme, the provider will bill the test for repeating standard testing during a routine exam, or simply bill for the more extensive code.  Look for providers with high utilization of this code reported on the same day as either E/M-Evaluation and Management services (CPT codes 99201-99205, 99211-99215) or Eye Exam codes (92002, 92004, 92012, 92014).  Consider providers who specialize in glaucoma care and compare against other specialists.

Advanced Color Vision testing

Some people have trouble seeing certain colors.  Poor color vision or “colorblindness” is usually inherited but can be caused by eye disease or some medications.  Certain occupations require completely functional color vision without any deficiencies, like a pilot, law enforcement and other jobs where recognizing color is vital.  When color vision loss is suspected, there are some specific tests that can be performed to determine the area and extent of loss.

What is the scheme?

Providers will unbundle basic color testing and bill more extensive color vision testing.  CPT 92283 (Color vision examination, extended, e.g., anomaloscope or equivalent) describes color vision testing that is more extensive and rigorous than is typically done during an eye exam. CPT directs, “Color vision testing with pseudoisochromatic plates (such as HRR or Ishihara) is not reported separately. It is included in the appropriate general or ophthalmological service.”[iii] The more common testing methods that support 92283 are the Farnsworth D-15, Farnsworth-Munsell 100-Hue, and the Nagel anomaloscope.

What should you look for?

Data mine for outliers as compared to like peers who are billing a higher than expected volume of either CPT code 92100 or 92283. 

If you have questions or are interested in learning more about Healthcare Fraud Shield’s FWA analytics, feel free to email us at SIU@hcfraudshield.com.

[i] Glaucoma, Open-angle

[ii] Medicine, 92100 (Q&A) (June 1998). CPT® Assistant

[iii] AAPC Coder

Quick Hits for Identifying Pharmacy and Medical Schemes on May 23rd, 2017 at 2:00 PM EST

Speakers:

Kenneth Cole, III, AHFI, CFE, CPC

Maria Seedorff, DC, AHFI, CPC

Kathleen Shaker, RN, BSN, CPC, CPC-H, AHFI

Karen Weintraub, MA, CPC-P, CPMA, AHFI

Click HERE to register!

If you would like to learn more about Healthcare Fraud Shield’s analytics solution, contact us at info@hcfraudshield.com.

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