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When billing 92326, do I need a modifier?

Marina Posted Mon 10th of September, 2012 17:44:12 PM

When billing 92326, do I need to use a modifier. Also, will Medicare pay for this code?

SuperCoder Answered Mon 10th of September, 2012 19:58:20 PM

We’ve broken down the codes according to whether the Medicare Physician Fee Schedule lists them with a 0, 1 or 2 indicator, with these definitions:

0 -- You cannot append modifier 50, but you can append LT or RT.

1 -- You can append modifier 50.

2 -- The code already specifies a bilateral procedure, so you should not append modifier 50, LT or RT to denote a procedure’s bilateral nature.

3 -- When performed bilaterally, append modifier 50 or LT/RT. Reimbursement is determined at 100 percent of the allowed for each side.

92326 falls under (Bilateral Procedure Indicator 0)Do not report this codes bilaterally

However, since the physician may measure the IOL strength in just one eye, 76519-26 and 92136-26 are unilateral.

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