92136 ophthalmic biometry

zwomack

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I am fairly new at coding for ophthalmology department and I am having an issue with the code 92136 ophthalmic biometry by partial coherence interferomety with intraocular lens power calculation. My confusion is two fold 1.) our provider is billing the 92136 1 unit w/dx of 366.16, then on the next line item is 92136-26 modifer 50 with the 366.16 as the dx code. I believe on the 2nd line item (92136-26) the 26 at the end of the code was placed in our system as a "in house" code and that it should be the modifer 26 to go with the 50 modifer. The 2nd line item 9213626 50 is being denied by MC as a CO-4 2). in the march 2009 coding edge, the article seems to state that this should be billed as 92136 tc RT & LT eye and then as 92136 PC RT LT eye. 3) the cpt and the coding companion doesn't state that this code is unilateral or bilateral. Which is the correct way for this code to be billed.

ZWomack
coding compliance coord.
 

companey

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I bill alot of 92136. For Medicare (ours is Palmetto) I bill 92136 with no RT or LT. They don't want it and for the 2nd Eye I bill 92136 modifier 26. Thats how Medicare wants it and and pays for it. For Non-Medicare payers they pay for both right and left. So I bill 92136 RT then 92136 LT.

Do you have the Book from American Academy of Ophthalmology called the Ophthalmic Coding Coach. I live by this book and it also as helped me win some appeals.

Hopes this helps:)
 

ciphermed

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Interesting....

There is a CPT Assistant (April '02), which indicates that from a coding perspective CPT 92136 is inherently unilateral however Medicare appears to consider the code inherently bilateral.

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