Print | ShareCPT Code: 92020 Region: 37
States covered: General guidelines if your state does not have a local coverage determination
Title: Gonioscopy
Category
Special Ophthalmological Services
Description
Gonioscopy is a technique for examining the visually inaccessible anterior chamber angle, the drainage apparatus of the eye otherwise known as the trabecular meshwork, and its anatomical relation to the adjacent iris.
This Medicare carrier does not have a local coverage determination (LCD) for gonioscopy. The policy presented is a sample and it is provided as a reference guide only and should not be construed as policy for your current Medicare carrier.
Gonioscopy is a technique for examining the visually inaccessible anterior chamber angle, the drainage apparatus of the eye otherwise known as the trabecular meshwork, and its anatomical relation to the adjacent iris. Using a special type of contact lens known as a goniolens that eliminates the internal reflectivity of the corneal curve, it allows light to be reflected from the angle so that its structures may be seen in detail and anomalies may be detected.
The two methods of gonioscopy are direct and indirect. In the more commonly used indirect method, a mirrored goniolens and biomicroscope enable examination of the anterior chamber angle opposite the direction of the view. Indirect gonioscopy can be undertaken using either a Goldmann lens or a Zeiss lens.
In contrast, direct gonioscopy uses a dome-shaped contact lens (goniosprism), which eliminates internally reflected light and allows direct visualization of the angle with a gonioscope.
Important functions of gonioscopy:
- Confirmation of normal angle structures
- Estimation of angle width (grading system)
- Pathological findings such as peripheral anterior synechiae (PAS); excessive pigmentation; abnormal blood vessels (neovascularization); angle recession secondary to trauma; plateau iris
Gonioscopy is a technique for examining the visually inaccessible anterior chamber angle of the eye using a special type of contact lens known as a goniolens.
Examination of the anterior chamber has four primary goals:
1. Confirmation of normal angle structures
- Schwalbe’s Line
- Trabecular meshwork
- Scleral spur
- Ciliary body
2. Estimation of angle width for glaucoma diagnosis and treatment
- Determination of any obstruction to aqueous outflow
3. Assessment of pathological findings of the angle such as those listed below:
- Peripheral anterior synechiae
- Excessive pigmentation
- Neovascularization
- Inflammatory deposits
- Cysts
4. Assessment of abnormalities of iris configuration such as those listed below:
- Angle closure
- Angle recession secondary to trauma
- Pupillary block
- Plateau iris syndrome
Identification and/or follow-up of the following:
1. Glaucoma
- Narrowness or closure of anterior chamber angle
- Historical evidence of angle closure
2. Disorders of the globe
3. Other retinal disorders
- Diabetic retinopathy
- Hypertensive retinopathy
- Vascular occlusions
- Retinal ischemia
4. Disorders of the choroid
5. Disorders of the iris and ciliary body
- Uveitis
- Vascular
- Hyphema
- Suspected neovascularization of the angle
- Degenerations
- Cysts
Adhesions and disruptions
6. Cataract
- Nuclear sclerosis
- After-cataract
7. Corneal pigmentation
8. Aphakia
9. Neoplasm of the eye
- Growth or tumor in the angle
10. Injury to the eye
- History or signs of penetrating ocular foreign body
- Evaluation for angle recession after trauma
11. Systemic disease
- Sarcoidosis
- Diabetes
- Congenital anomalies
12. Post-operative management of ocular surgery
- Pseudo-aphakia
- Complication of IOL
ICD-10 Diagnosis Codes
Medical record documentation maintained by the ordering/referring eye doctor should indicate the medical necessity for performing the service and the results. This information is usually found in the history and physical, office/progress notes, or test results.
Documentation must be available to Medicare upon request.
The diagnosis code(s) must best describe the patient’s condition for which the service was performed.
- Gonioscopy done under general anesthesia should be billed using CPT code 92018 – Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; complete.
- CPT code 92020 represents a bilateral service. Modifiers RT, LT, or -50 are not valid and should not be used.
- CPT code 92020 has no technical or professional components. Modifiers TC or -26 are not valid and should not be used.
Payable places of service: office, urgent care facility, inpatient hospital, outpatient hospital, emergency room, ambulatory surgical center, skilled nursing facility, nursing facility, and independent clinic.
Although there are no specific utilization guidelines for gonioscopy, the service may be performed at the following intervals for most cases:
- For primary angle closure glaucoma, gonioscopy may be paid 4 times for the first year after diagnosis and 2 times per year for established cases thereafter
- For primary angle closure glaucoma acute attack, gonioscopy may be paid every 24 hours until Laser Peripheral Iridotomy (LPI), and then up to 4 times within the first year, every six months thereafter for one year, and then annually
- For other covered ICD-10 codes, gonioscopy is generally required one or two times per year
- Claims not meeting the criteria stated in these guidelines may be denied