Wiki OCT optic nerve 92133 and OCT retina 92134

[miedemarebecca@gmail.com]

Hi, I am an ophthalmology coder and in my experience it is not allowed and not payable EVER to bill both the OCT optic nerve 92133 with OCT of retina 92134. One of the doctor's I'm coding for was displeased I had to remove one of these as I explained they bundle. The Dr said this does not make sense as patient has macular edema and glaucoma which are entirely different conditions that would prompt both distinct testing. Now I am curious if any of you know if there is a way around this edit perhaps? I billed the claim and ultimately will follow it to see if it gets denied.

 

[acr0929]

Procedure (92133) is in Column One and procedure (92134) is in Column Two in the NCCI Edits. You may not report these two procedures together even with a modifier, even though they may have been done for unrelated problems.

In a RAC topic, CMS states, "Based on CPT Code descriptions, CPT Code 92133 and/or 92134 cannot be reported at the same patient encounter. CPT codes 92133 and/or 92134 will be considered in this edit, if billed together during the same patient encounter, on the same date of service. Only one is allowed per day, therefore the less comprehensive CPT/HCPCS Code - 92134 will be recovered as an overpayment."

https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Approved-RAC-Topics-Items/0159-Ophthalmic-Diagnostic-CPT-Codes-Excessive-Units-

I would code only the optic nerve OCT, 92133, since it it the more comprehensive procedure.