Wiki 99204, 92250, 92133, 92020

[ncharba]

I was wondering if this is how I would bill an E/M 99204-25 with 92250, 92133 and 92020 using modifiers.

99204-25
92250
92133
92020-XU

 

[natashalage]

hello,
no modifier is needed because there is no surgical procedure.
92250 and 92133 are bundled, so you will bill 92133 because it has higher RVU
92020 is good to go.

 

[Cheezum51]

You don't need the 25 on the E/M code nor the XU on the 92020 because it isn't bundled with any of the tests. As stated previously, you can't bill photos and OCT on the same date of service.

Tom Cheezum, OD, CPC, COPC

 

[Edmundo]

Hi @ncharba - It's a pleasure.

You may be able to unbundle CPT 92250 & 92133 using the modifier 59, depending on the payer. Usage of the modifier 59 is rare but it does occur in some instances. Please review the article published by the American Academy of Ophthalmology.

Unbundling 92250 with 92133 or 92134 - American Academy of Ophthalmology (aao.org)


Edmundo Gonzalez, CPC, COPC, OCS