Ophthalmology and Optometry Coding Alert

Question: Can I report 92235 times two, bilateral eyes for each visit? Per the 2007 Coding Companion for Ophthalmology, it states that a physician photographs both eyes.

California Subscriber

Answer: You can report 92235 (Fluorescein angiography [includes multiframe imaging] with interpretation and report) per eye and code it twice when your ophthalmologist performs the test on both eyes. Depending on your carrier's preference, you should append modifier 50 (Bilateral procedure) or modifiers LT (Left side) and RT (Right side) to 92235 when billing bilaterally.

You can confirm that billing 92235 bilaterally is appropriate by checking its bilateral status indicator on the Medicare physician fee schedule, available at http://www.cms.hhs.gov/PhysicianFeeSched/. Code 92235 has a "3" status indicator. That means when a physician performs the service bilaterally, you can append modifier 50 or LT/RT. Carriers will reimburse you at 100 percent of the allowed for each side.