Tag Archives | Ophthalmic

Switch From 92135 to New Location Based SCODI Codes

 These terms nail down your diabetic retinopathy imaging code choice.

In CPT® 2011 in the place of your old familiar SCODI code, you’ll find three area specific codes. Check out these tips on finding the correct code for imaging as well as DR services.

Code 92135 is being split into three more specific codes. The scanning computerized ophthalmic diagnostic imaging or SCODI code got used a lot in 2010 and was a high volume code. CPT 2011 deletes the code. Pick the new code based on the particular area the imaging is performed on as follows:

Area CPT 2011 Code Descriptor
Front of the eye 92132 Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral
Optic nerve 92133 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve
Retina 92134 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina


92227 Vs. 92228: Look at DR Status

Diabetic retinopathy is the leading cause of blindness. Yet early detection makes the condition correctable 95 percent of the time. Imaging retina center technicians can easily look at a photo and read it. The ophthalmologist can then determine if the patient has DR, the stage it’s in, and the proper course of treatment.

Equate the term “Detection” that’s in new diabetic retinopathy imaging code 92227 (Remote imaging for detection of retinal diseases [e.g., retinopathy in a patient with diabetes] with analysis and report under physician supervision, unilateral or bilateral]) with “screening” for diabetic retinopathy. “Use this…

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Pre-Cataract Surgery Coding Myths You Should Bust

Improperly coding IOL Masters or A-scans can cost your practice $30 per patient.

Calculating intraocular lens power for patients facing cataract surgery has gotten more precise as A-scan and IOL Master technology has advanced. But to make sure your practice is getting fairly reimbursed each time, you need to understand the bilateral rules for 76519 and 92136.

Could one of these myths be damaging your claims?

Include Bilateral and Unilateral Components in Global Code

Myth: If the ophthalmologist calculates IOL power in both eyes, you should report 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation) or 92136 (Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation) twice (e.g., 76519-RT and 76519-LT, or 76519-50).

Reality: You should not report 76519 or 92136 with modifier 50 even if the ophthalmologist calculated the IOL power of both eyes, warns Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, Director, Best Practices-Network Operations at Mount Sinai Hospital in New York City. To understand why, it’s helpful to know how Medicare’s Physician Fee Schedule values the procedures.

As it does with many other diagnostic tests, CMS divides the A-scan (76519) and the IOL Master (92136) into two components. The technical component (the actual performing of the test) is denoted with modifier TC, and the professional component (viewing and interpreting the results) is denoted with modifier 26.

For most procedures, the technical and professional components have the same bilateral status – for example, 92250-TC and 92250-26 (Fundus photography with interpretation and report) are both considered inherently bilateral, denoted with modifier indicator “2” on the fee schedule. The reimbursement for all components of 92250 is based on both eyes being tested.

Exception: For both 76519 and 92136, the technical component has a different bilateral status from the professional component. You can find…

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Optometry Coding: Stop 92081-92083 Denials in Their Tracks

Record visual fields interpretation and report the right way.
Visual fields are a compliance hot spot. Optometrists should use the visual field interpretation and report (I&R) to record what their thinking process was at that moment by recording any changes noticed, how the field compares to other testing like OCT (92135, Scanning computerized ophthalmic diagnostic imaging, […]

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Cataract Surgery Coding Skill Builder

Determine ‘planned or unplanned’ before separately coding vitrectomy.
With several possible surgical treatments for cataract procedures, which you probably code more often than any other surgery, there’s a lot of room for error – with over $890 at stake for complex cataract procedures in 2009.
Use these tricky scenarios as a guide through some of the most […]

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  3. Optometry Coding: Eye Exams, Cataract Surgery and Co-ManagementE/M or Eye Code? Choose Wisely With These Documentation Tips…
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Trigeminal Nerve, in yellow.

Neurosugery Coding: 3 Easy Steps Distinguish Between 61790 & 61791

Anatomy know-how points you in the right direction every time.
How do you tell the difference between 61790 (Creation of lesion by stereotactic method, percutaneous, by neurolytic agent [e.g., alcohol, thermal, electrical, radiofrequency]; gasserian ganglion) and 61791 (… trigeminal medullary tract)?
That’s the question a Neurosurgery Coding Alert reader posed when she wrote, “What is the difference […]

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