Several issues are surfacing in vision care regarding "pupil dilation" (the actual process of inducing mydriasis with various drugs) and "dilated examination" of certain parts of the eye (retina, vitreous, lens, etc.). Pupil Dilation procedure (decide which drop, put it in, wait 30-40 minutes) is used to give the doctor a better view of certain eye structures, but it has never had its own procedure code and doctors rarely charge specifically for the service of inducing dilation. A few vision plans, however, do pay separately for the dilation service and presently have no way to code it.
CPT has wrestled with the issue for years and the current CPT definitions of most ophthalmological services leave the dilation optional. A "92004" comprehensive eye examination, for example, must include a look at the retina, but the doctor can dilate or not dilate without affecting the validity of the 92004 code. My main question has to do with local medical quality guidelines developed unilaterally by some payors that have the effect of expanding the CPT-4's definition of a coded service. For example, can a local Medicare carrier state that all 92004 and 92002 procedures "must be done with dilated pupils", if the CPT code definition is silent on "dilation" or leaves it optional? It is beginning to look like we should request a CPT code for the dilation procedure, but my present question is only regarding the legality of local medical review policies essentially expanding a code's definition. Thanks, -Chris Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268 ********************************************************************** To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=business and enter your email address.
