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? decreased reimbursement when billed out together to MC on the same day.

Kathy Posted Mon 13th of May, 2013 18:39:20 PM

Is reimbursement decreased (for 92133) when billing out 93083 and 92133 on the same day to Medicare?

SuperCoder Answered Wed 15th of May, 2013 03:58:56 AM

Hi,

Please check,93083 is an invalid code.

Thanks.

Kathy Posted Wed 15th of May, 2013 12:05:21 PM

SHOULD BE 92083 AND 92133. THANKS.

SuperCoder Answered Wed 15th of May, 2013 12:28:25 PM

The optical coherence tomography test, code 92133 (Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve), is considered bilateral, and payment is for both eyes. The correct modifier to use would be modifier 52 (Reduced services), but most payers will pay the same amount regardless of whether only one eye was tested.

An OCT test is inherently bilateral. The fee allotted for 92133 accounts for what is involved in scanning both eyes.
When your optometrist performs the scan bilaterally, you should only report the code once. Do not report 92133 either on two lines — one line with modifier RT (Right side) appended and the other line with LT (Left side) appended — or on one line with modifier 50 (Bilateral procedure) appended.
Code 92133 has a bilateral modifier indicator of "2" in Medicare's Physician Fee Schedule. This means that the usual bilateral payment adjustment does not apply. Medicare (and payers who follow Medicare rules) will only reimburse the allowable amount for a single code — $44.93 for 92133 (1.32 RVUs multiplied by Medicare's 34.0376 conversion factor.
More modifiers: Code 92133 can be split into technical and professional components if your physician doesn't own the OCT equipment. You would report 92133-TC (Technical component) for the technical component only and 92133-26 (Professional component) if the provider interpreted the results.

Be sure to check your contractor's local policies before reporting 92133. You may find some contractor-specific requirements associated with the code. For instance, many contractors have their own rules for reporting 92133 at the same time as other tests, and some contractors have specific guidelines on how often you can perform OCT screenings on a patient.

Kathy Posted Thu 16th of May, 2013 12:24:10 PM

MY QUESTION IS/WAS ~IS REIMBURSEMENT DECREASED WHEN AND OCT (92133) AND VISUAL FIELDS (92083) ARE BILLED OUT TOGETHER (TO MEDICARE) ON THE SAME DAY? WILL WE GET MORE MONEY IF THEY ARE BILLED OUT ON DIFFERENT DAYS? HOPE THIS IS CLEAR. THANK YOU

SuperCoder Answered Fri 17th of May, 2013 10:41:03 AM

To bill the GDx use the code 92133 with no modifiers required. This is now a bilateral code.

When billing Medicare you cannot bill other procedures same day as with the visit (92xxx, 99xxx,etc.) and 92133 (GDx scan). All additional procedures may be denied.

When considering referrals follow same rules as visual fields (92083). If a referral is needed for a visual field then a referral will be needed for a GDx.

Most insurances will cover up to 2 GDx scans per calendar year if medical necessity warrants. It is more common to perform a GDx (92133) once per calendar year and also a visual field (92083) once per calendar year. Many practitioners have adapted seeing the patient every 6 months and alternating the tests (Visual Field 6months-GDx 6 months-Visual Field 6 months-GDx 6 months and so on).

1) There is no CCI bundling between these 2 codes - 92083 and 92133. 92083 holds higher RVU value for more physician work.

Many Medicare carriers will cover 92133 annually for glaucoma or glaucoma suspects (365.00-365.9), every six months for low tension glaucoma (365.12), and more frequently based on the patient's specific circumstance. For this reason, the diagnosis is key to getting reimbursed. You should also check the documentation for the reason the optometrist orders the diagnostic OCT. The reason stated in the patient's record has to demonstrate medical necessity for payers to reimburse you on 92133.

If the patient needs to come back for referral or scheduling reasons, the provider should document the reason he ordered the test in the previous dictations. If the provider does the OCT the same day, the physician should still document the test order and the reason for the test.

In addition: For you to submit 92133, your physician must include a written interpretation and report that details any findings and observations he made from the imaging report.

An OCT test is inherently bilateral. The fee allotted for 92133 accounts for what is involved in scanning both eyes. When your optometrist performs the scan bilaterally, you should only report the code once. Do not report 92133 either on two lines — one line with modifier RT (Right side) appended and the other line with LT (Left side) appended — or on one line with modifier 50 (Bilateral procedure) appended.

Be sure to check your contractor's local policies before reporting 92133. You may find some contractor-specific requirements associated with the code. For instance, many contractors have their own rules for reporting 92133 at the same time as other tests, and some contractors have specific guidelines on how often you can perform OCT screenings on a patient.

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