Wiki Any 92136 - Opt Biometry - Denials in 2017

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briansmith99

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Hello!

Just checking to see if anyone else has gotten denials from major payors in 2017. We've followed the same processes as in previous years, billing 92136 for the first pre-op visit before cataract surgery and billing 92136 - 26 (LT or RT) on the second eye when the patient is pre-op for that eye.

We aren't getting denials across the board so I wondered if maybe we got something random or if there was a stealthy change in 2017 for this code.

Thanks!
 
I put a call into medicare on this subject and was informed that effective 1/1/17 the eye modifier is no longer needed on the biometry claims. 92136 for the first eye and when billing the second bio they say the 26 modifier is appropriate but LT and RT and not appropriate. I wasn't able to get documentation on that change from medicare over the phone and I am looking for that now. Any hints appreciated!
 
Effective January 1, 2017, per CMS, the Bilateral indicator changed from 3 to 2 on the professional component of 92136 and 76519, which would explain why they want the RT/LT dropped (just like SLT's in 2016)
 
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92136 bilaeral scan & interrpretation of first eye

I have been reading so many guidelines and articles on billing 92136.
I understand billing 92136 for the actual bilateral scan
I understand billing the interpretation of the second eye

Can we bill for the interpretation of the first eye or is that included in the actual scan?
Thanks, Kerry
 
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