Kathy Posted Mon 06th of May, 2013 16:56:17 PM
A 92133 along with a 92134 was billed to Medicare on the same day. Each with a differenct diagnosis. The 92133 was paid the 92134 was denied with "not covered when performed during the same session as a previously processed svc." Medicare said a modifier was necessary. What would you recommend?
SuperCoder Answered Tue 07th of May, 2013 21:20:15 PM
Choose Between 92133 and 92134 for Inconclusive HRT
Report 92133 (Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve) or 92134 (… retina) for the Heidelberg Retina Tomograph (HRT) study. Report the global code without appending modifier TC (Technical component).
In this case, your practice performed both the technical component and the professional component. Even if the provider could not make a final diagnosis based on the test, if he looked at the report and documents the findings, he gets credit for the professional component.
In the absence of a final diagnosis, report an ICD-9 code that describes the symptoms that prompted the test -- for example, 379.9x (Unspecified disorder of eye and adnexa), or 796.4 (Other abnormal clinical findings) if the patient has increased intraocular pressure, which could indicate glaucoma.