Wiki 92134 OCT and Medicare

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marandee

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My Ophthalmologist uses this OCT test for Glaucoma progression. Medicare denies code. Would this be bundled into the 92012 for a patient who is having their glaucoma progression reviewed by doctor?
 
It's not bundled with the 92012 and you shouldn't have to use the 25 modifier. I have heard, from several sources recently, that some Medicare carriers are all of a sudden classifying the OCT scan codes as "experimental" and refusing to pay for them. That is incorrect and they are just doing that to see if they can get away with not having to pay for the procedure.

I would appeal the non payment to the carrier and see what happens. If they still refuse to pay, then report them directly to CMS for violating CMS policy.

Tom Cheezum, O.D., CPC, COPC
 
Thank you Tom.
I do not put -25 modifier on these claims. Per Medicare LCD, will not cover...92134 for glaucoma progression review..... but I think the wrong test code was used. I will review again and try to get it appealed if not an issue for a corrected claim.
Deirdre Marangiello, CPC
 
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Deirdre,
I just realized something. The 92134 is used mainly for AMD and other retinal problems.

The 92133 scan is for the optic nerve head which is more appropriate for glaucoma. Perhaps that's the problem with your claims.

Tom Cheezum, O.D., CPC, COPC
 
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