Wiki 92250 and 92133/92134

[PattyGreen]

Found articles that indicate you can't bill these during the same visit. Why? Coding Coach indicates there are limited clinical conditions that allow this combo by adding -59 to 92250. What are these? Where might I find literature/documentation stating these rules and the explanation? Thanks!

 

[dkeown]

Found articles that indicate you can't bill these during the same visit. Why? Coding Coach indicates there are limited clinical conditions that allow this combo by adding -59 to 92250. What are these? Where might I find literature/documentation stating these rules and the explanation? Thanks!

You might want to check with your insurance carrier to determine whether they will accept these codes. I know that the LCD for Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) for our region specifically states you generally would not bill these services together; however, when you do, the medical necessity must be clearly stated in the record. If our physicians can clearly demonstrate why both were necessary and are willing to submit the required documentation, we will submit both charges.

Hope this helps!

David Keown, CPC, OCS

 

[PattyGreen]

Thank you

I appreciate the help!

 

[depaul]

I did ophthalmology billing/coding for several years. When we did the OCT and Fundus photos we had the pt make an appt to return for those. We did not do the test at the same time as an offc visit. I added -59 on the photos 92250 code. Never had a problem getting the claim paid with any carrier.

Diane B, CPC, CEMC

 

[rhotonscott]

5. Fundus photography (CPT code 92250) and scanning ophthalmic computerized diagnostic imaging (CPT code 92135) are generally mutually exclusive of one another in that a provider would use one technique or the other to evaluate fundal disease. However, there are a limited number of clinical conditions where both techniques are medically reasonable and necessary on the ipsilateral eye. In these situations, both CPT codes may be reported appending modifier 59 to CPT code 92250.
National Correct Coding Initiative Policy Manual
for Medicare Services
Version 16.3
Effective Date: October 1, 2010
National Correct Coding Initiative
Correct Coding Solutions, LLC
Final Due Date: August 31, 2010
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Current Procedural Terminology (CPT) is copyright 2009 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
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