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Thread: 92136 rules Palmetto Medicare

  1. #1

    Default 92136 rules Palmetto Medicare

    AAPC: Back to School
    Most of our docs do A scan for IOL calcs on both eyes the same day but bill 92136 for the eye having surgery first. Then in a few months when the patient is ready for the other eye 92136-26 is billed for the other eye when surgery is scheduled. This is printed in the Coding Coach. We are receiving denials from Palmetto M'care J11 now and I need help. How to bill now?

    Is it better to bill both eyes 92136, 92136-26 the same day or continue doing as above except now it seems Palmetto M'care wants 92136-52 for the first eye and 92136-26 for the second eye. In order to bill both eyes for 92136 does this mean both eyes have to have cataract extraction the same day? Any help would be much appreciated.

  2. #2
    Join Date
    Apr 2007

    Default A scan

    We normally use 76519 for A scan and medicare in NOVA area (Palmetto) changed their rule and we got bunch of rejection, so you will use it as
    76519 TC 52
    76519 26
    First SX or second eye doesn't matter.

  3. #3
    Join Date
    Apr 2007
    Lexington Kentucky Chapter


    So, what does the LCD from Palmetto state for this code? Usually an indication of how they prefer the test to be billed.

    David Keown, CPC, OCS

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