Article

Coding & Reimbursement

Still “a thing:” Extended color vision testing

Extended color vision testing is not new, and clinicians continue to find it valuable. Even so, the test is sometimes overlooked. It shouldn’t be; here’s what you need to know.

Q. What is extended color vision testing, and what is its purpose?

A. Color vision testing is performed for a variety of reasons including suspicion of congenital or acquired color vision defects, vision-related optic nerve problems and monitoring high-risk medications.1 Performance and safety vocational assessment for color vision is also important in some occupations, such as aviation.2

Q. What CPT code describes this test?

A. Basic color vision testing with pseudoisochromatic plates, such as the Hardy-Rand-Rittler (HRR) or Ishihara, is incidental to an eye exam. Thus, the test is not billed separately.

CPT 92283 (Color vision examination, extended, eg, anomaloscope or equivalent) describes color vision testing that is more extensive and rigorous than is typically done during an eye exam. CPT directs, “Color vision testing with pseudoisochromatic plates (such as HRR or Ishihara) is not reported separately. It is included in the appropriate general or ophthalmological service.” The more common testing methods that support 92283 are the Farnsworth D-15, Farnsworth-Munsell 100-Hue and the Nagel anomaloscope.

Q. Is this covered by Medicare and other payers?

A. Sometimes. Since basic color vision testing using pseudoisochromatic plates is covered as part of the eye exam, more extensive color vision testing may be ordered when a patient fails the basic color vision test or has a sign, symptom or family history that warrants further assessment. Coverage depends on the indications as well as the results of the extended testing and the doctor’s interpretation.

Generally, this and all diagnostic tests are reimbursed when medically indicated. Clear documentation of the reason for testing is always required. Too-frequent testing can garner unwanted attention from Medicare and other payers.

Q. Are there bundles affecting coverage?

A. According to Medicare’s National Correct Coding Initiative (NCCI), CPT 99211 (technician visit) is bundled with 92283, although other exam codes are not. It is not bundled with other tests.

Q. How much does this test pay?

A. CPT 92283 is per patient, not per eye. As expected, each payer has its own fee schedule. For the sake of reference, the 2019 national Medicare Physician Fee Schedule allowable is $54.78. Of this amount, $45.41 is assigned to the technical component and $9.37 is for the professional component. Medicare allowable amounts are adjusted in each area by local indices.

This test is subject to Medicare’s Multiple Procedure Payment Reduction (MPPR). This reduces the allowable for the technical component of the lesser-valued test when two or more tests are performed on the same day.

It is also important to remember that this test is rare within the Medicare program. For ophthalmology, it was reported with only about 1% of all exams. That is, 92283 was associated with about one of every 100 exams. For optometry, the rate was slightly higher at about 1.5%. Because most color vision testing is performed as an incidental part of an eye exam, the utilization of 92283 is significantly less than the prevalence of color vision deficit in the population.

Q. What documentation is required in the chart?

A. A physician’s order is necessary; an interpretation should discuss the results of the test and treatment (if any). A brief notation such as “abnormal” does not suffice.

In addition to the images (or notation where they are stored), good documentation includes:

  • Patient name and date of the test
  • Physician’s order (eg, Extended color vision testing to rule out Plaquenil macular toxicity — patient unable to complete 10-2 HVF)
  • Reliability of the test (eg, Prompt responses)
  • Findings (eg, Some red-green defects noted OU)
  • Assessment, diagnosis (eg, Plaquenil macular toxicity OU; no prior Hx of color vision defects)
  • Impact on treatment, prognosis (eg, Recommend discontinuing Plaquenil, letter to Rheumatology)
  • Physician’s signature (eg, I.C. Better, MD)

Q. What are the supervision requirements?

A. Under Medicare program standards, this test needs only general supervision. “General supervision” means the procedure is furnished under the physician’s overall direction and control, but the physician’s presence is not required. State laws may vary.

Q. If coverage is unlikely, how do we get paid?

A. Explain to the insurer why the test is necessary and that Medicare or other third-party payers will likely deny the claim. Ask the patient to assume financial responsibility for the charge. A financial waiver can take several forms, depending on insurance.

An Advance Beneficiary Notice of Noncoverage (ABN) is required for services where Part B Medicare coverage is ambiguous or doubtful and may be useful where a service is never covered. You may collect your fee from the patient at the time of service or wait for a Medicare denial. If both the patient and Medicare pay, promptly refund the patient or show why Medicare paid in error.

For Part C Medicare (Medicare Advantage), determination of benefits is required to identify beneficiary financial responsibility prior to performing noncovered services. Medicare Advantage plans have their own waiver processes and are not permitted to use the Medicare ABN form. For commercial insurance beneficiaries, a Notice of Exclusion from Health Plan Benefits (NEHB) is an alternative to an ABN. OM

REFERENCES

  1. Fraunfelder FT, Fraunfelder FW, Chambers WE. Clinical Ocular Toxicology: Drug-Induced Ocular side Effects. Elsevier Health Sciences. 2008;320-321.
  2. Rayman RB, Davenport ED, Dominguez-Mompell R, et al. Rayman’s Clinical Aviation Medicine. 5th Ed. Castle Connelly Graduate Medical Publishing. 2006;251-253.