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92136 IOL Master

Lisa Posted Wed 19th of March, 2014 15:51:19 PM

If a patient has a 92136 done and later decides to cancel surgery, can we still bill the 92136 with mod 52 to indicate that the PC of the procedure was not done? If the patient presents almost 1 year later, can the 92136-26 be billed?

Or since the service was provided, can we still bill 92136-RT even though the sx cancelled?

SuperCoder Answered Thu 20th of March, 2014 10:00:31 AM

I am working on this and will reply soon.


SuperCoder Answered Thu 20th of March, 2014 10:00:31 AM
WIth me
Lisa Posted Thu 27th of March, 2014 13:14:06 PM

Anyword yet?

SuperCoder Answered Thu 27th of March, 2014 16:29:57 PM

I am in consultation with my CE on this. Will reply soon.


SuperCoder Answered Thu 27th of March, 2014 16:29:57 PM
SuperCoder Answered Mon 31st of March, 2014 08:44:58 AM

If only the technical portion of 92136 was performed, with no interpretation (professional component) of the test, the coder should report 92136-TC to represent just the technical component. Modifier 52 should not be required. Payment will be for the technical component only for 92136 for both eyes, as 92136-TC is considered inherently bilateral.

As far as I can tell, there are no rules specifically addressing how long you can wait between reporting the technical component and the professional component of a diagnostic test. Therefore, if the patient presents back a year after the test was performed, and then the ophthalmologist interprets the earlier test, the coder may be able to report 92136-26-50 at that time – modifier 26 identifies it as the professional component, and modifier 50 identifies it as a bilateral service. Modifier 50 is necessary because unlike the technical component, the professional component of 92136 is inherently unilateral.

If the ophthalmologist only interprets the test performed on one of the eyes, the coder would omit modifier 50 and instead append modifier LT or RT.

However, if it’s been a year since the original test was performed, the ophthalmologist may want to redo the technical component anyway, in case there have been changes in the eye since the original test.

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