Wiki Ophthalmology diagnostic coding & needed modifiers

achughes

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I work for an Ophthalmology practice. Frequently, our doctors will bill an OCT (92134 or 92133) along with a Fundus Photo (92250), Visual Fields (92083), and maybe FA (92230 or 92235) or ICG (92240). I've been receiving denials from Medicare and other payers (in Pennsylvania) stating "bundled or not medically necessary". I know there are instances where multiple diagnostics are permitted when appropriate physician documentation is in place. For a line-up of the below codes, please advise correct modifiers and on which codes they are appropriate for Medicare and commercial insurance:
92083
92133 or 92134
92250

Also, if anybody knows the LCD that addresses this, please advise.

Thanks for your help.
 
In general, according to NCCI edits, you can't perform and bill for 2 different types of "imaging" procedures on the same day. OCT, photos and FA are all imaging procedures and will be denied if done on the same day. Visual fields can usually be done the same day as any of these imaging procedures.

I have heard that some carriers will pay for multiple imaging procedures done the same day if a different diagnosis is attached to each one, but those instances seem rare from what I've seen and heard,

Tom Cheezum, O.D., CPC
 
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