Ophthalmology and Optometry Coding Alert

Question: A staff member used modifier -AP appended to CPT code 92012. I've searched everywhere - what does it mean and when does one use it?

California Subscriber

Answer: Today, you probably shouldn't use it at all. Modifier -AP (Determination of refractive state was not performed in the course of diagnostic ophthalmological examination) simply tells the carrier that the ophthalmologist did not determine the patient's refractive state during the course of performing 92012 (Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient).
 
Modifier -AP became unnecessary after 1992, when CMS implemented a new system for calculating RVUs. Before 1992, the values for eye exam CPT codes 92002-92014 included the value for refraction. If an ophthalmologist performed an eye exam without refraction, he would append modifier -AP to show that the fee did not include refraction.
 
In 1992, CPT gave refraction its own code, 92015 (Determination of refractive state), which Medicare will not reimburse for, and excluded that work from the value of the eye exam codes. Since refraction is now no longer considered an intrinsic part of any code, modifier -AP is no longer necessary.