Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., and Rebecca Wartman, O.D.
From the July/August 2015edition of AOA Focus, pages 50-51.
Optometric vision therapy has been shown to be an effective treatment modality for many types of problems affecting the vision system. Vision therapy services include the diagnosis, treatment and management of disorders and dysfunctions of the vision system including, but not limited to, conditions involving binocularity, accommodation, oculomotor disorders and visual perceptualmotor dysfunctions. However, the exact length and nature of the therapy program can vary with the specific complexity of the diagnosed condition.
There are only a finite number of codes you will use in the vision therapy portion of your practice. These codes can be subdivided into: examination procedure codes, diagnostic codes, and therapeutic procedure codes. In all of the code choices, the most important factor is documentation. There are several procedural codes that could be used for an office visit to determine if the patient has an ocular, visual or visual perceptual problem: 92002, 92004, 92012, 92014, 99201-99205, or 99211-99215. After determining the patient needs additional testing, you have several coding options: 92060 (sensorimotor exam), 96110.(developmental testing; limited), 96111 (developmental testing), and 96116 (neurobehavioral status exam).
When simply performing orthoptics, the appropriate code to use is 92065. It is uncommon though for an optometrist providing any form of comprehensive vision therapy to do only orthoptics. When performing other procedures, you may want to consider the Physical Medicine and Rehabilitation codes (97000 series):
- Code 97110 for therapeutic exercises to develop strength and endurance, range of motion and flexibility. This could be used for working with convergence insufficiency or accommodative dysfunctions.
- Code 97112 for neuromuscular reeducation of movement, balance coordination, kinesthetic sense, posture and proprioception. This is often used for eccentric fixation training.
- Code 97530 for therapeutic activities utilized to restore a patient's functional performance with dynamic activities, such as training in specific functional movements or activities performed during daily living routines. This could be used to train a patient with oculomotor/saccadic dysfunctions that are impacting performance.
- Code 97532 for interventions used to enhance cognitive skills, (e.g., attention, memory, problem solving) with direct (one-on-one) patient contact by the clinician.
- Code 97533 focuses on sensory integrative techniques to enhance sensory processing and to promote adaptive responses to environmental demands, with direct (one-on-one) patient contact by the clinician.
After therapy has been initiated, you may choose to re-examine the patient at regular intervals. As long as you have the required documentation for history, examination and medical decision-making, you have several coding choices. These would include the same as the initial assessment and may include the special testing codes covered previously. Because the patient has already been seen in the office, only the established patient codes would be applicable.
Because of the differences in complexity of conditions and management approaches, this information should be used only as a guideline. Ultimate responsibility for the correct submission of claims and responses to any remittance advice lies with the provider of services.
Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2023, the AOA continues to press for Congress to act on reforms that would give doctors of optometry an annual, permanent inflationary Medicare payment tied to the Medicare Economic Index.
The federal government and private payers are heavily scrutinizing the use of modifier -25. When used appropriately, it can help to ensure that patients receive appropriate treatment and that doctors of optometry are reimbursed appropriately for their service. If you believe a claim that includes modifier -25 was inappropriately denied, follow appropriate criteria when appealing.