Medical necessity rules are met when a patient presents with a sign or symptom of dry eye as determined by the clinician, which should be documented in the patient's medical record. Codes commonly used for coding dry eye diagnosis and/or dry eye symptoms, as referenced in the clinical literature, are listed in the "ICD-10 Coding for Dry Eye" brochure, available on the TearLab website.
Currently CMS has no National Coverage Determinations (NCD) that define diagnosis codes to bill for CPT 83861 tear osmolarity test, so a decision to perform a test based on signs or symptoms of dry eye is up to the physician. Florida Medicare Providers, please refer to "Florida First Coast LCD" on the TearLab website for information on Medicare coverage for dry eye testing.
Always ensure that all the items listed below in "Documenting a Laboratory Test" are included in the patient record to meet medical necessity guidelines.
Medicare has several requirements for documenting laboratory tests such as tear osmolarity, which must be noted in the patient chart or Electronic Health Record (EHR). Please ensure that every tear osmolarity test performed is documented appropriately as follows:
1. The sign or symptom of disease that prompted the ordering of the test.
2. A notation in the medical record that a "tear osmolarity test was ordered" with "tear osmolarity" specifically identified.
3. The numerical tear osmolarity test results and indication if the results were normal or abnormal.
4. Treatment/Management Plan - the medical action taken as a result of the tear osmolarity test, and referencing the test results in the plan.
5. Managing clinician's signature at the end of the record indicating that everything in the record that day was reviewed and confirmed as medically necessary.
Note that Medicare and most commercial payers do not cover screening tests, thus a sign or symptom of dry eye, or a previously diagnosed but "unstable" dry eye under management, must be properly documented prior to submitting a claim for reimbursement for a tear osmolarity test.
Disclaimer: The information provided on this website is current as of January 2017 and was obtained from third-party sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, policies, and payment amounts. All content on this website is informational only, general in nature, and does not cover all situations or all payers' rules and policies. This content is not intended to instruct hospitals and/or physicians on how to use or bill for healthcare procedures, including new technologies outside of Medicare national guidelines. A determination of medical necessity is a prerequisite that TearLab Corporation assumes will have been made prior to assigning codes or requesting payments.
Under Federal and State law, it is the individual provider's responsibility to determine appropriate coding, charges and claims for a particular service. Policies regarding appropriate coding and payment levels can vary greatly from payer to payer and change over time. TearLab Corporation recommends that providers contact their own regional payers to determine appropriate coding and charge or payment levels.
If you are a provider participating in a clinical trial, we recommend you contact your payers, including Medicare/Medicaid and private insurers, to verify correct coverage and reimbursement policies for investigational devices.
This website information represents no promise or guarantee by TearLab Corporation concerning coverage, coding, billing, and payment levels. TearLab Corporation specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information on this website.