Ophthalmology and Optometry Coding Alert

Question: How should we code 92135 when both eyes are done? Does modifier -50 apply to this code?

New York Subscriber

Answer: The confusion you have about how to code 92135 (Scanning computerized ophthalmic diagnostic imaging [e.g., scanning laser] with interpretation and report, unilateral) probably stems from the inclusion of "unilateral" in the procedure definition. You may also be aware that many procedures can't be coded using the conventional bilateral-procedure modifier, -50, when they are nonsurgical procedures performed on paired body areas, e.g., the eyes.

But coding for bilateral SCODI is surprisingly straightforward. If you are billing Medicare, submit code 92135 on one line with modifier -50 (Bilateral procedure) attached. In other words, the coding scenario should be 92135-50.

Other payers' policies may vary, so you should check with the carrier before submitting the claim, but they will typically have you bill 92135 twice with the right eye modifier, -RT, appended to one of the codes and the left eye modifier, -LT, appended to the other. You might also be instructed to code 92135 with a 2 in the units field.