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OCT testing professional component

  1. #1
    Default OCT testing professional component
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    Is there something I'm missing? I am a hospital physician coder and my ophthalmologists interpret the OCT's. We do all types of OCT scans. Can the doctor be reimbursed for his services with a modifier 26 added to the procedure code in addition to a modifier 25 added to the E/M or EYE Code for the visit? Additionally, what CPT code can I use for the OCT? There is only one CPT code 92136 for coherence biometry and occasionally the OCT testing includes IOL power calc's, but rarely. Most often the OCT scans are stand-alones without additional data, and I don't see any codes for this in the CPT book. I feel my doctors should get reimbursed for these interps, they require expertise and time!
    Badboy
    CPC,OCS

  2. Default
    Quote Originally Posted by rhotonscott@yahoo.com View Post
    Is there something I'm missing? I am a hospital physician coder and my ophthalmologists interpret the OCT's. We do all types of OCT scans. Can the doctor be reimbursed for his services with a modifier 26 added to the procedure code in addition to a modifier 25 added to the E/M or EYE Code for the visit? Additionally, what CPT code can I use for the OCT? There is only one CPT code 92136 for coherence biometry and occasionally the OCT testing includes IOL power calc's, but rarely. Most often the OCT scans are stand-alones without additional data, and I don't see any codes for this in the CPT book. I feel my doctors should get reimbursed for these interps, they require expertise and time!
    I don't know what you mean by "hospital physician coder" but if you are like I am, I code for hospital based physicians (providers). OK....if we're in the same boat.....

    The code for OCT is 92135. You add a modifier 26 to it for the physician interpretation only portion. The hospital bills the TC (technical component) separately. Just make sure you have an order and that the interpretation is not part of the E/M or Eye code clinic visit/note. It must be a separate interpretation, even if the reason for the test and findings are mentioned in the dictation or handwritten doctor's notes.

    I don't understand why you need to attach a 25 modifier to the visit. The OCT is not a surgical code. Also, the coherence biometry - 92136 (or IOL Master as it is referred to) is one way to measure for the IOL that is not with ultrasound. The ultrasound way is 76519.

    You need to add the 26 modifier to any diagnostic test code when you are billing for the physician interpretation of it only.

  3. #3
    Default still want interp reimbursement!!!!!!
    It is my understanding that anytime an additional procedure is done as part of an E/M service (ex Avastin injection during office visit) a modifier -25 has to added to the E/M code for the separate, identifiable service. Of course, there are restrictions to this, as when the procedure has already been scheduled. If you are scheduled for YAG, then there is no E/M service, just a procedure code for the visit. But the separate note requirement seems to make sense. That will never happen where I work, but I still feel the interpreting physician should be reimbursed for this expertise and time. They actually write the OCT, FA, etc. interp on the encounter, not just acknowledge that they interpreted the OCT.
    Badboy
    CPC,OCS

  4. Default
    Quote Originally Posted by rhotonscott@yahoo.com View Post
    It is my understanding that anytime an additional procedure is done as part of an E/M service (ex Avastin injection during office visit) a modifier -25 has to added to the E/M code for the separate, identifiable service. Of course, there are restrictions to this, as when the procedure has already been scheduled. If you are scheduled for YAG, then there is no E/M service, just a procedure code for the visit. But the separate note requirement seems to make sense. That will never happen where I work, but I still feel the interpreting physician should be reimbursed for this expertise and time. They actually write the OCT, FA, etc. interp on the encounter, not just acknowledge that they interpreted the OCT.
    The injection code ( 67028), whether you are injecting Avastin, Kenalog, Macugen, Lucentis or whichever drug, is a surgical procedure so you do attach a 25 modifier to the E/M if the decision for the injection was made at that visit but the OCT is not a surgical code so you do not need the 25 on the E/M when doing diagnostic tests on the same day as the E/M.

    Intravitreal injections, YAG lasers, PRPs, etc. are surgical codes. The tests are not.

    If the physicians do not write a separate interpretation, on a separate piece of paper (or however they document) - something that is separately identifiable from the general visit note, they cannot bill for the interpretation separately.

    You need the order with medical necessity (the order can be inferred from the notes) and you need the interpretation elsewhere from the clinic note (and/or in addition to).

  5. #5
    Default
    who ever you are, god bless you!!! As a beginning coder doing physician eye clinic coding, your knowledge is like GOLD to me!!!! Thanks!!!
    Badboy
    CPC,OCS

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