92275_R05

1.  All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.

2.  Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service(s).  The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.

3.  The submitted medical record must support the use of the selected ICD-10-CM code(s).  The submitted CPT/HCPCS code must describe the service performed.

4.  The medical record documentation must support the medical necessity of the services as directed in this policy.

5.  The medical record must include the test results.  Documentation should also reflect how the test results were used in the patient’s plan of care.

6.  When reporting ICD-10 code Z79.899, the medical record must reflect the medication administered as well as the underlying condition for which it was given.

1.  Report an ERG with CPT code 92275.  This is a bilateral test, therefore no modifiers are required if both eyes are examined.

2.  An ERG test is usually reported globally, but it may be separated into a professional component (modifier -26 and a technical component (modifier -TC) if necessary.

3.  ERG test can be done with general or direct supervision by the optometrist/ophthalmologist depending on if the technician is certified or non-technicians are now able to become certified by the American Board of Physical Therapy Specialties (ABPTS) to perform sensitive and complex neurophysiological studies.  If your technician is certified, an ERG test may be performed under general supervision (the doctor is not immediately available).  If your technician is not ABPTS certified, an ERG test must be performed with direct supervision (doctor is immediately available).

4.  An eye examination may be reported on the same day as a ERG test if it is medically necessary.

Medicare has no specific utilization guidelines for ERG testing.  In the absence of specific utilization guidelines, ophthalmologists/optometrists should adhere to CMS Ruling 95-1 (V) which states that utilization of these services should be consistent with locally acceptable standards of optometric or medical practice.