OCT is quickly becoming an integral part of optometric practice. From a coding standpoint, OCT was first introduced in 1999 with code 92135, scanning computerized ophthalmic diagnostic imaging (e.g., scanning laser) with interpretation and report, unilateral—a broad, non-anatomically specific code representing all ocular OCT procedures. In January 2011, 92135 was replaced with three new codes with anatomically-specific application and rule sets:
92132: scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral.
92133: scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve.
92134: scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina.
With these new codes came new edits within the National Correct Coding Initiative (CCI) identifying areas of conflict when performing these tests on the same day as other commonly performed procedures or with each other.
Fundus photography with interpretation and report—92250—and either 92133 or 92134 cannot be performed on the same date of service on the same patient. The 2017 CMS policy manual states:
Fundus photography (CPT code 92250) and scanning ophthalmic computerized diagnostic imaging (e.g., CPT codes 92132, 92133, 92134) are generally mutually exclusive of one another in that a provider would use one technique or the other to evaluate fundal disease. However, there are a limited number of clinical conditions where both techniques are medically reasonable and necessary on the ipsilateral eye. In these situations, both CPT codes may be reported appending modifier 59 to CPT code 92250.
This language is problematic for those who view the -59 modifier as a “magic trick” for getting around this rule set. The clinical conditions that warrant both techniques are few and far between, and billing these two on the same day should be very rare.
New technology, such as OCT-A, often tempts clinicians to get creative with coding to embellish their reimbursements. But OCT-A should be reported with CPT 92134 only, without additional codes such as 92499 (unlisted ophthalmic procedure). The broad definition of 92134 easily encompasses the application of angiography, and no additional code should be used.
The better and more integrated the technology, the more integral the provider’s clinical acumen. For example, clinicians must assess the patient’s clinical presentation and which structure/image is the most clinically applicable when deciding on the proper code—not simply bill both the fundus photograph and the OCT, or bill only the fundus photography for a higher reimbursement.
The November 2014 CPT Assistant clarifies coding OCT procedures with a clinical example: Our office performs fundus photography examinations using a scanning laser which produces a fundus photograph. Is it appropriate to report CPT code 92135 for this method of examination of the fundus?
CPT’s answer drives home the point: “It is important to note that if the only necessary service provided is generating a fundus photograph without the need to quantify the nerve fiber layer thickness and to analyze the data via a computer, then reporting code 92250 is appropriate, even if the photograph was taken with a scanning laser.” The reverse is true as well; if an instrument captures both images simultaneously, the clinician must determine which is most clinically relevant prior to the point of capture.
As OCT technology progresses and combined imaging becomes more common, the burden of proper test application, interpretation and subsequent coding of those tests will increase for the clinician. Stay tuned as policies continue to change.
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