Wiki 92250/92235 coding to medicare

[riverloverjen38@yahoo.com]

Quick question. Does anyone know if Medicare changed the way to code 92250 and 92235 in 2013? I always bill with tc/26 for both procedures. Now I am getting denials. I bill like this.....
92250 TC
92250 26

92235 TC RT
92235 26 RT

92235 TC LT
92235 26 LT

Is this correct?

 

[annawade13]

It's my understanding that if you are performing the technical and professional component of a service, you would bill that service once with no modifiers. I would bill:

92250
92235 -RT
92235 -LT

What do your denials say? As far as I know, there are no CCI edits for these codes. Maybe it's an unbundling error.

 

[mitchellde]

You would not bill bilateral as 2 lines for Mcare it would be
92250
92235 50

Unless this is a RHC then it is a little different.
But I agree it really depends on what the denial states.

 

[HDaniels]

I agree, the 92250 does not need to have the TC or 26 modifier if you are providing both. I bill this code on a regular basis to Medicare and it is always paid as long as there is a DX supporting the necessity of the test.
The 92235 is in need of the 50 modifier if bilateral or the RT/LT if unilateral

 

[collinsm]

92250/92235

I bill the 92235; and the 92250 with modifier 59 and the claims do not get denied.