Ophthalmology and Optometry Coding Alert

Question: We performed SCODI on both of a patient’s eyes and used modifiers LT (Left side) and RT (Right side) to show that the services were bilateral, but we haven’t gotten paid for both sides. What’s the problem?

Illinois Subscriber

Answer: Unfortunately, you won’t be able to collect bilateral payment for this service. Code 92134 (Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina) is inherently bilateral, so the reimbursement you collect for the code accounts for what is involved in scanning both eyes. Therefore, when your eye care physician performs the scan bilaterally, you should only report the code once.

In addition, do not report 92134 on two lines — one line with modifier RT (Right side) appended and the other line with LT (Left side) appended — or on one line with modifier 50 (Bilateral procedure) appended. You should also keep in mind that 92134 has a bilateral modifier indicator of “2” in Medicare’s Physician Fee Schedule. This means that the usual bilateral payment adjustment does not apply. Medicare (and payers who follow Medicare rules) will only reimburse the allowable amount for a single code or one unit of service.