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Susan Answered Fri 24th of June, 2011 12:10:13 PM

We saw a patient for an eye exam that was done under moderate sedation. Code 92018 is with general anesthesia. What code should we use?

SuperCoder Answered Fri 24th of June, 2011 19:01:47 PM

CPT codes 92018 and 92019 (ophthalmological examination and evaluation, under general anesthesia . . .) are generally not separately reportable with ophthalmological surgical procedures. The examination and evaluation of an eye while a patient is under general anesthesia for another ophthalmological procedure is integral to the procedure. However, there are unusual circumstances when an adequate ophthalmological examination cannot be completed without anesthesia (e.g., uncooperative pediatric patient, severe eye trauma). In such situations CPT codes 92018 or 92019 may be separately reportable with appropriate documentation.

SuperCoder Answered Fri 24th of June, 2011 19:18:41 PM

I agree with this opinion. At the same time, I suggest the following:
1. We need to tell the physicians these procedures reimbursible specifically under general anesthesia.
2. If coded under Moderate sedation, and the provider demands for remibursement, then we should code with 52 modifier[this is not based on any rule], with the reason submitted; OR as instructed by the Carrier.

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