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Ophthalmology and Optometry Coding Alert

Reader Question:

Base Bilateral Coding on LMRP Rules

Published on Fri Aug 01, 2003

Question: How should I report ocular coherence tomography (OCT) when my ophthalmologist performs it in both eyes at the same surgical session?

Maine Subscriber
 
Answer: The CPT code for OCT, 92135 (Scanning computerized ophthalmic diagnostic imaging [e.g., scanning laser] with interpretation and report, unilateral), is inherently unilateral, which means you should append either modifier -50 (Bilateral procedure) with a 1 in the units column or the alpha-modifiers -LT (Left side) and -RT (Right side) with a 2 in the units column when the procedure is performed bilaterally.

When a code is inherently unilateral, the fee Medicare (or a private carrier) allots for the code only accounts for what work is involved when the procedure is performed in one eye only. In the case of 92135, the fee for this service only accounts for scanning done in one eye.

You have to check your carriers policies to determine their preferred method of reporting bilateral OCT. Most Medicare carriers prefer that you report 92135-50 for bilateral OCT, but many private carriers prefer that you use the alpha-modifiers and report two units of service. In either case remember: OCT is billed per eye, not per patient.

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