Optometry Coding & Billing Alert

Published on Wed Oct 20, 2004 PDF

An article in the August 2004 Optometry Coding and Billing Alert, "Perfect Your Coding Technique With These Expert Scenarios," suggested reporting CPT code 92135 (Scanning computerized ophthalmic diagnostic imaging [e.g., scanning laser] with interpretation and report, unilateral) with 92250 (Fundus photography with interpretation and report).

Those two codes are bundled as "mutually exclusive" by the National Correct Coding Initiative, which means you can't report them together for Medicare. The modifier indicator for the bundle is 1, meaning that it is possible to report the two codes together, but only by appending modifier -59 (Distinct procedural service) when the documentation warrants it. Private payers may accept the two codes together without modifiers.

"It's not clear to me why Medicare bundles these two codes," says David R. Gibson, OD, FAAO, a practicing optometrist in Lubbock, Texas. "My source says it has to do with their concern about overutilization of code 92135. I haven't seen any guidelines for what constitutes proper documentation or reason for the services being 'distinct.' I would assume an example would be a case where each of the bundled tests are documenting different conditions - for example, if the scanning laser were for glaucoma progression while the fundus pictures were documenting change in diabetic retinopathy."

Subscribers to this publication can relate their experiences on the online Optometry Coding Discussion. Visit http://www.coding911.com/join_optometry.html to join. We welcome your input.