Ophthalmology and Optometry Coding Alert

Question: Can I code an electroretinogram bilaterally?

Colorado Subscriber

Answer: CPT® code 92275 (Electroretinography with interpretation and report) is an inherently bilateral service, according to Medicare. Payment – which averages $147.67 nationally – is based on the procedure being performed on both eyes. The normal 150 percent payment adjustment for bilateral reporting would not apply in this case.

Code 92275 describes an electrophysiologic test of retinal function, performed on a patient who has been dark adapated and fitted with a recording contact lens and a reference electrode attached to the forehead. Light flashes are then produced and the electrical activity generated by the retina is recorded. The test can detect diseases and changes before ophthalmoscopic changes occur, or when cataracts or corneal opacity prevent ophthalmoscopic exam. The test can even be performed on babies.

Do this: If your ophthalmologist performs the test on only one eye, append modifier 52 (Reduced  services) to note the lesser-than-usual work performed. Make sure the operative notes reflect that only one eye was tested, and append modifier LT (Left side) or RT (Right side) to CPT® code 92275, depending on which eye was tested.