Ophthalmology and Optometry Coding Alert

Question: My Medicaid carrier just requested repayment for all claims for fundus photography performed on the same day as nerve head analysis with an OCT. Should I appeal this? Alabama Subscriber Answer: You certainly can appeal, but your chances aren't good. The Correct Coding Initiative (CCI) places 92250 (Fundus photography with interpretation and report) in a "mutually exclusive" bundle with 92135 (Scanning computerized ophthalmic diagnostic imaging [e.g., scanning laser], with interpretation and report, unilateral), also known as optical coherence tomography (OCT). Many carriers see 92250 as a procedure that would not be necessary along with 92135. The bundle may be a result of Medicare's concern about providers overusing 92135. The rule has caused many ophthalmologists to try to avoid performing 92135 and 92250 on the same day unless medically necessary, due to health or transportation problems with the patient. For example, an ophthalmologist might perform OCT at a six-month progress [...]