Optometry Coding & Billing Alert

Published on Mon Aug 10, 2015 PDF

Question: The optometrist is monitoring a patient who has glaucoma and diabetic retinopathy. He checks the glaucoma’s progression with a scanning laser test and takes fundus photographs to track changes in diabetic retinopathy. How would I code this visit?

North Carolina Subscriber

Answer: Report CPT® code 92134 (Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina) for the scanning laser, and 92250 (Fundus photography with interpretation and report) for the fundus photographs.

Don’t miss: Be sure you link a glaucoma diagnosis, such as 365.11 (Primary open-angle glaucoma), to 92134, and a diabetic retinopathy code, such as 362.05 (Moderate nonproliferative diabetic retinopathy), to 92250.

Your documentation must support the medical necessity for each test. In such a situation, you may want to have the patient sign an advance beneficiary notice (ABN) in case the carrier denies the claim.

A scanning laser test is inherently bilateral. The fee allotted for 92134 or 92133 (Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve) accounts for what is involved in scanning both eyes.

When your optometrist performs the scan bilaterally, you should only report the code once. Do not report 92133 or 92134 either on two lines — one line with modifier RT (Right side) appended and the other line with LT (Left side) appended — or on one line with modifier 50 (Bilateral procedure) appended.

Codes 92133 and 92134 have a bilateral modifier indicator of “2” in Medicare’s Physician Fee Schedule. This means that the usual bilateral payment adjustment does not apply. Medicare (and payers who follow Medicare rules) will only reimburse the allowable amount for a single code:

• 92133: $44.34 (1.24 RVUs multiplied by Medicare’s 35.7547 conversion factor

• 92134: $45.51 (1.27 RVUs multiplied by Medicare’s 35.7547 conversion factor.