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Thread: Help need 2011 code for OCT

  1. #1
    Join Date
    Apr 2007
    Carolina Coders Charlotte NC

    Default Help need 2011 code for OCT

    AAPC: Back to School
    Optical coherence tomography (OCT)-
    Scanning computerized ophthalmic diagnostic imaging, posterior segment with interpretation and report, unilateral. What's the 2011 code?

  2. #2
    Join Date
    Apr 2007
    Kansas City, MO


    92133- everything you said...plus it says "unilateral or bilateral;optic nerve"

    92134 " " ;retina

  3. #3


    You will use either:
    92132 anterior segment; unilateral or bilateral
    92133 posterior segment (optic nerve); unilateral or bilateral
    92134 posterior segment (retina); unilateral or bilateral

    Payment, Documentation and Utilization rules for new codes:

    1. You are only getting paid per scan now NOT per eye.

    2. You cannot report 92133 & 92134 at the same patient visit

    3. Check your Medicare LCDs and Commercial Carrier updates for documentation requirements.

    Anterior scan (92132) may be denied as experimental unless your chart documentation reflects the following exceptions:
    • Narrow angle, suspected narrow angle, and mixed narrow and open angle glaucoma.
    • Determining the proper IOL for a patient who has had prior refractive surgery and
    now requires cataract extraction.
    • Iris tumor
    • Presence of corneal edema or opacity that precludes visualization of the anterior
    • Calculation of lens power for cataract patients who have undergone prior refractive
    surgery. Payment will only be made for the cataract codes as long as additional
    documentation is available in the patient record of their prior refractive procedure.
    Payment will not be made in addition to A-scan or IOL master.

    4. Utilization Limits (again check you Medicare LCDs)
    • Two scans per year for suspected of having or diagnosed with glaucoma.
    • One scan every 2 months for primary diagnosis is related to a retinal disease.
    • One scan per month for active treatment for macular degeneration or diabetic

    Hope this helps.
    NOVA Medical Billing, Inc.

  4. #4
    Join Date
    Apr 2007
    Greater Atlanta

    Default 2011 code for OCT

    We know we can't bill for both the 92133 and the 92134, but what if they are done on the same day? Do you bill the 92133 OR the 92134?

    Thank you for any help.
    Inpt & Outpt Coder

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