Wiki CPT 9220 92134

[fami]

Hi All,

Any information regarding billing these two together, as OUTPT services? NCCI EDIT, MUTUALLY EXCLUSIVE procedure edit.
RECORD INDICATED:
OCT MACULA [OD NORMAL, OS MIDLY IMPROVED
OPTOS [OD WNL, , OS INFERIOR CYRSTALS & OVERLYING HEMORRHAGE]

Thanks,]

 

[Cheezum51]

You can't bill an OCT and retinal photos on the same date of service. NCCI edits prohibit it.

Tom Cheezum, OD, CPC, COPC

 

[kcioe@nwiea.com]

This is from cms.gov:
SCODI (92133, 92134) and fundus photography (92250) are mutually exclusive codes. However, there may be a limited number of clinical situations in which it is necessary to perform both techniques in order to evaluate and treat the patient. In these situations, both CPT codes may be reported appending modifier 59 to indicate a distinct procedural service. Documentation supportive of the need to perform both techniques should be clear in the medical record.

We tracked a couple claims, and as long as distinctly different diagnosis codes are assigned to each, and the 59 modifier is attached to the OCT, we have been reimbursed by both Blue Cross and Medicare.