Ophthalmology and Optometry Coding Alert

Question: We performed a test on a patient in a SNF, and Medicare denied it, saying that the SNF was responsible for payment. Is there a list somewhere of what codes Medicare will cover while a patient is in a SNF, and what codes the SNF is responsible for?


Iowa Subscriber


Answer: Coding services for SNF patients falls under consolidated billing. The SNF is responsible for most of the care the patient receives under Part A, and the SNF should reimburse you directly for those procedures.

You can find Medicare's 2006 consolidated billing files online at www.new.cms.hhs.gov/SNFConsolidatedBilling/02m_2006Update.asp.

Exception 1: Medicare excludes physician services from consolidated billing--instead of billing the SNF, you should bill your Part B carrier for those services. CMS excludes all of the E/M codes (99201-99350) and eye exam codes (92002-92014) as physician services, as well as virtually all of the eye surgery procedure codes. For the complete list, see "File 1" at the above URL.

Exception 2: For diagnostic tests that have both a professional component and a technical component (for example, 92250, Fundus photography with interpretation and report), Medicare wants you to split the bill.

The SNF is responsible for the technical component, while you can report the professional component to your Part B carrier with modifier 26 (Professional component) appended to the CPT code for the service.

To get paid for the technical component, submit a bill to the SNF with modifier TC (Technical component) appended to the code. For a list of these codes, see "File 2" at the above URL.