CODING Q&A

New Retinal Ophthalmic Diagnostic Testing Codes for 2011

Information Provided By Riva Lee Asbell

CPT code 92135 has been deleted for 2011. Three new codes are to be used for OCT. The new codes are for anterior segment, posterior segment, optic disc, and posterior segment, retina.

92132: Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral.

92133: Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve

92134: retina

► Do not report 92133 and 92134 at the same patient encounter.
► Code 92135 has been deleted.
► For scanning computerized ophthalmic diagnostic imaging of optic nerve and retina, see 92133, 92134.

The significant change from CPT code 92135 to codes 92132, 92133 and 92134 is that SCODI is now paid once for both sides whereas it was formerly paid for each side.

For Medicare, bill only one charge and use the quantity “1” whether you do the test on one or both eyes. Do not use modifier 50 or bill separately with RT and LT modifiers.

You can expect bundles of the above codes in the NCCI (National Correct Coding Initiative).

REMOTE IMAGING FOR DR: TWO NEW CODES

92227: Remote imaging for detection of retinal disease (eg, retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral.

92228: Remote imaging for monitoring and management of active retinal disease (eg, diabetic retinopathy) with physician review, interpretation and report, unilateral or bilateral.

► Do not report either 92227 or 92228 in conjunction with 92002 to 92014, 92133, 92134, 92250, or with the evaluation and management codes of the single-organ system, the eye, codes 99201 to 99350.

“These codes are required to meet the needs of diabetic retinopathy screening programs, which provide remote imaging and data submission to a centralized reading center. Code 92227 is intended for reporting a screening examination for the asymptomatic patient at risk for… diabetes mellitus-associated retinopathy. Code 92228 is intended for reporting remote imaging required for monitoring and management of patients with active retinal disease.”

Q & A

Q. Will this be billable with fundus photography (CPT code 92250)?

A. The NCCI edits will appear either in version 17.0 (January 1, 2011) or version 17.1 (April 1, 2011). At this time, I think it is safe to assume that 92133 and 92134 will be bundled with 92250.

Q. Can 92133 and 92134 be used on the same visit?

A. No, they cannot be billed at the same patient encounter, per CPT instructions. Most likely, an NCCI bundle for the two codes will be issued.

Q. Please confirm that the 92133 would apply to an OCT of the optic nerve (99% sure that it is).

A. CPT code 92133 is designated for testing of the optic nerve by code description, as noted in the beginning of the article.

TIPS

All the new codes have the requirement of “interpretation and report.” The article on my Web site (www.RivaLeeAsbell.com) titled “The Three C's: Interpretation and Report Requirements for Diagnostic Testing” and found under “Articles” outlines what you should be doing.

► Check for NCCI bundles.
► Watch for LCDs from your contractor for the new codes — also associated billing articles. These will give you the diagnoses that are covered and other important information.
► Signature requirements by Medicare, particularly in respect to CERT audits, should be reviewed and adhered to. Be sure the order for the test is signed as well as the Interpretation and Report. RP

CPT codes ©2011 American Medical Association