Specular microscopy is an easy, and cost-effective, step to add after the exam lane if you know how to properly bill for the procedure.

The specular microscopy procedure is used to measure endothelial cell counts of the cornea. There is tendency for fluid to accumulate in the cornea, sometimes causing it to swell. Endothelial cells pump fluid from cornea to maintain relative dehydration, cornea transparency, and clarity. At birth, endothelial cell count (density) is about 5,000 cells/mm but slowly decreases with age. In pathologic conditions, this reduction in cell count may prevent dehydration of the cornea so it becomes cloudy and non-transparent.

As a result, specular microscopy has become a common procedure. To help you properly code for the procedure, here are some important tips to keep in mind. Additionally, the chart below shows disease codes associated with specular microscopy.

Specular microscopy is billed with CPT 92286, Special anterior segment photography with interpretation and report; with specular endothelial microscopy and cell count.

Medicare’s Correct Coding Initiative (CCI), which some non-Medicare plans also follow, indicates that for 92286, there is only one code not usually billed at the same visit—99211 (E/M Office or Other Outpatient Services). The 92286 code is the only service paid if both codes are billed because 99211 is “bundled” into 92286.

However, 99211 is paid (in addition to 92286) if modifier 25 is attached to it. Modifier 25 will bypass the CCI edits. Modifier 25 “Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service” may represent a different session or patient encounter, different procedure, different site or organ system, or separate lesion not ordinarily encountered or performed on the same day by the same physician.

The 92286 code may be separately payable by Medicare preoperatively with cornea and cataract surgery when the patient has had prior surgery on the same eye, endothelial dystrophy, corneal edema, posterior polymorphous dystrophy of cornea, blunt trauma history, exfoliation syndrome, irido-corneal-endothelium syndrome, history of glaucoma, or other condition that adversely affects the cornea endothelium. Yet, with the conditions above present, if the only visual problem is cataracts, 92286 is not separately paid by Medicare.

For Medicare, nothing is paid or can be collected from the patient when 92286 is performed pre-operatively in the absence of cornea disease.

In addition, the national Medicare payment average for 2012 is $122.54, a 3% increase over 2011. Most non-Medicare plans pay at least that much and often much more.

Alan Homestead is an optometric physician practicing in Seattle and a consultant on coding issues and practice management.

364.00 Acute and subacute iridocyclitis, unspecified
364.01 Primary iridocyclitis
364.02 Recurrent iridocyclitis
364.03 Secondary iridocyclitis, infectious
364.04 Secondary iridocyclitis, noninfectious
364.10 Chronic iridocyclitis unspecified
364.11 Chronic iridocyclitis in diseases classified elsewhere
364.21 Fuchs’ heterochromic cyclitis
364.22 Glaucomatocyclitic crisis
364.23 Lens-induced iridocyclitis
364.24 Vogt-Koyanagi syndrome
364.3 Unspecified iridocyclitis, uveitis
364.51 Essential or progressive iris atrophy
364.52 Iridoschisis
364.53 Pigmentary iris degeneration
364.54 Degeneration of pupillary margin
364.55 Miotic cysts of pupillary margin
364.56 Degenerative changes of chamber angle
364.57 Degenerative changes of ciliary body
364.59 Other iris atrophy
364.61 Implantation cysts (of iris, ciliary body, anterior chamber), epithelial down-growth
366.21 Localized traumatic opacities
366.22 Total traumatic cataract
366.23 Partially resolved traumatic cataract
366.32 Cataract in inflammatory disorders
366.33 Cataract with neovascularization
371.20 Corneal edema, unspecified
371.21 Idiopathic corneal edema
371.22 Secondary corneal edema
371.23 Bullous keratopathy
371.24 Corneal edema due to wearing of contact lenses
371.32 Folds in Descement’s membrane
371.33 Rupture in Descement’s membrane
371.50 Corneal dystrophy, unspecified
371.51 Juvenile epithelial corneal dystrophy
371.52 Other anterior corneal dystrophies
371.53 Granular corneal dystrophy
371.54 Lattice corneal dystrophy
371.55 Macular corneal dystrophy
371.56 Other stromal corneal dystrophies
371.57 Endothelial corneal dystrophy, cornea guttata, Fuchs
371.58 Other posterior corneal dystrophies, polymorphous corneal dystrophy
371.82 Corneal disorder due to contact lens
379.31 Aphakia
379.32 Subluxation of lens
379.33 Anterior dislocation of lens
743.35 Congenital aphakia
743.20 Buphthalmos, unspecified
743.21 Simple buphthalmos
743.22 Buphthalmos associated with other ocular anomalies, keratoglobus, megalocornea
906.5 Late effect of burn of eye, face, head, and neck
940.2 Alkaline chemical burn of cornea and conjunctival sac
940.3 Acid chemical burn of cornea and conjunctival sac
940.4 Other burn of cornea and conjunctival sac
996.51 Mechanical complication of other specified prosthetic device, implant, and graft, Due to corneal graft
996.53 Mechanical complication of other specified prosthetic device, implant, and graft, Due to ocular lens prosthesis
996.60 Infection and inflammatory reaction due to internal prosthetic device, implant, and graft, Due to unspecified device, implant and graft
996.69 Infection and inflammatory reaction due to internal prosthetic device, implant, and graft, Due to other internal prosthetic device, implant and graft
996.89 Complications of transplanted organ, Other specified transplanted organ
998.59 Postoperative infection, Other postoperative infection
998.82 Cataract fragments in eye following cataract surgery
V42.5 Organ or tissue replaced by transplant, Cornea
V43.1 Organ or tissue replaced by other means, Lens, Pseudophakos (for patients having secondary intraocular lens implant)
V45.61 States following surgery of eye and adnexa, Cataract extraction status (for patients having secondary intraocular lens implant)
V45.69 States following surgery of eye and adnexa, Other states following surgery of eye and adnexa (for patients who had previous intraocular surgery and require cataract surgery, and patients about to be fitted with extended wear contact lenses after intraocular surgery)
V53.1 Fitting and adjustment of spectacles and contact lenses (use to code fitting extended wear contact lenses after intraocular surgery)
V72.83 Other specified preoperative examination (for patients having surgery associated with higher risk to corneal endothelium) (medical record must have description of planned surgery associated with higher risk to corneal endothelium, when billed with V72.83)



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