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92226

Pessie Posted Mon 13th of December, 2010 21:06:00 PM

Is there a difference in coding "92226" LT and RT on one line 2units or 2 lines 1 unit each? Thank You

SuperCoder Answered Tue 14th of December, 2010 16:36:28 PM

For bilateral procedure, 92226 should better be billed with modifier 50.

Pessie Posted Tue 14th of December, 2010 16:36:33 PM

anyone available to answer if it really matters if 92226 or 92135 are billed on one line or two?

Pessie Posted Tue 14th of December, 2010 16:43:01 PM

I got a denial for 92226 with modifier 50 unit 2, (and more often than not it is approved), and the agent told me to bill modifier 50 as unit 1 is that correct?

SuperCoder Answered Tue 14th of December, 2010 16:43:24 PM

If you are going to use modifier 50, you can't bill it with 2 units, because, this itself implies that we are billing the Bilateral portion of the CPT itself.

There is also a General Guideline on Billing unilateral codes with specific reference to: 92135, 92225, 92226, 92235, 92240 eye codes.

When billing both eyes for unilateral codes a best practice is to identify each procedure with a -RT or -LT informational modifier and put a quantity of one if billed on separate lines or quantity 2 if billed on the same line in the CMS 1500 claim.

Example:
92135-RT qty: 1 (Best Practice)
92135-LT qty: 1 (Best Practice)
or
92135-RT -LT qty: 2

Pessie Posted Tue 14th of December, 2010 17:48:53 PM

Thank You

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