Wiki OCT vs Fundus Billing

[kathy a]

I have a question regarding OCT and Fundus exams. I was told to bill for the Fundus exam and not the OCT due to NCCI edits. I noticed though that the OCT has higher RVU's for the physician than the Fundus. I work for a hospital based clinic. Which one would you bill out for ?
Thank-you

Kathy Albert, CPC

 

[Cheezum51]

I assume you're referring to an OCT scan and funds photos that are done on the same date of service? The NCCI edits do say that you can theoretically bill for both on the same DOS using a 59 modifier. However, you most likely won't get paid for both and may cause more trouble for yourself than that's worth.

That being said, I'd bill for the funds photos because the reimbursement is higher than for OCT. Also, I'd encourage your providers not to order both tests on the same day but do one at one visit and order the second for the next visit, assuming both are really necessary.

Tom Cheezum, O.D., CPC, COPC

 

[MSCALLIE79]

If they are performing the fundus 92250 and OCT 92133 or 92134 for the same reason/diagnosis. The fundus and OCT bundle and I $0.00 charge the Oct due to fundus has a higher reimbursement. If they are performing for two separate reasons/diagnoses. You can unbundle with
- XU or -59 (depending on payer) and documentation will support reason for payment because rhe insurance may request documentation review

 

[kathy a]

Thank you for your help !