Print | ShareCPT Code: 92100 Region: 37
States covered: General guidelines if your state does not have a local coverage determination
Title: Serial Tonometry
Category
Special Ophthalmological Services
Description
Serial tonometry is used during the course of medical treatment of acute elevations of intraocular pressure, e.g., acute angle-closure glaucoma.
This Medicare carrier does not have a local coverage determination (LCD) for scanning computerized ophthalmic diagnostic imaging, posterior segment. The policy is a sample and is provided as a reference guide only and should not be construed as policy for your current Medicare carrier.
Serial tonometry is used during the course of medical treatment of acute elevations of intraocular pressure, e.g., acute angle-closure glaucoma. The professional service may also be used to assess diurnal variations of intraocular pressure when glaucoma is suspected.
In patients with glaucoma the primary goal of treatment is to reduce the intraocular pressure. In addition, it is also important to reduce the range of diurnal fluctuation that a patient experiences over the course of the day.
In patients without glaucoma the normal diurnal curve is approximately 4 mmHg. In patients with glaucoma if the intraocular pressure varied more than 11 mmHg over a given day, patients had a 15% stability rate. In these patients if the diurnal range was lowered to 7 mmHg the stability rate was nearly tripled.
Serial tonometry may also be helpful in patients with newly-diagnosed glaucoma. Before beginning treatment, serial tonometry enables the doctor to gain a better understanding of the patient’s circadian intraocular pressure measurements.
Also, repeating the test several months into the treatment plan can help to determine if the glaucoma is under good control.
Last, serial tonometry may be helpful in patients whose glaucoma appears to be progressing in spite of intraocular pressure measurements that are consistently within the target pressure range.
1. Identification and/or follow-up for glaucoma suspect
- To establish or exclude glaucoma in patients with optic nerve damage or other signs/symptoms of glaucoma without documented elevation of intraocular pressure
2. Identification and/or follow up for glaucoma
- Confirming the diagnosis of glaucoma when used to assess diurnal variations of intraocular pressure in the evaluation of established glaucoma
3. Identification and/or follow-up for acute angle-closure glaucoma
- To guide treatment during the course of acute care for symptomatic or potentially dangerous elevations of intraocular pressure
ICD-10 Diagnosis Codes
| ICD-10 Codes | Description |
|---|---|
| H44.511 - H44.513 | Absolute glaucoma |
| H40.001 - H40.003 | Preglaucoma, unspecified |
| H40.011 - H40.013 | Open angle with borderline findings, low risk |
| H40.031 - H40.033 | Anatomical narrow angle |
| H40.051 - H40.053 | Ocular hypertension |
| H40.021 - H40.023 | Open angle with borderline findings, high risk |
| H40.11X1 - H40.11X3 | Primary open-angle glaucoma |
| H40.1211 - H40.1233 | Low-tension glaucoma |
| H40.231 - H40.233 | Intermittent angle-closure glaucoma |
| H40.211 - H40.213 | Acute angle-closure glaucoma |
1. The medical record should clearly indicate the condition being evaluated and the primary diagnosis should support the medical necessity of the service (e.g. urgent treatment of acute elevation of intraocular pressure or diagnostic diurnal curve determination).
2. The medical record must be made available to Medicare upon request.
There are no coding guidelines associated with CPT code 92100.
- CPT code 92100 represents a bilateral service. Modifiers RT, LT, or -50 are not valid and should not be used.
- CPT code 92100 has no technical or professional components. Modifiers TC or -26 are not valid and should not be used.
Although there are no frequency guidelines, there are guidelines regarding the clinical circumstances where serial tonometry may be medically necessary.
1. Serial tonometry is not indicated in the routine follow-up of glaucoma. In general, the need for serial tonometry should be an infrequent occurrence for any given patient and in any given office.
2. It is inappropriate to bill for serial tonometry simply because tonometry is performed more than once during an examination. Payment for routine measurement of intraocular pressure is included in the allowance for an eye examination and this applies even if measurements are repeated during the course of the examination.
3. Confirmatory measurement of a particular finding with the same or different tonometers, or with different personnel, does not constitute serial tonometry.