92135 and 92250

My doctor wants to do an OCT 92135 and a Fundus Photo 92250 on the same visit. According to the Ophthalmology coding companion book, it states that it is inappropriate to bill both 92135 and 92250 together, but the doctor says they are separate tests for different dx’s. One gives measurements and one gives the picture of the very back of the eye. I cannot seem to get the claim thru Medicare, it always denies as inclusive. Has anyone else had luck in getting these two services paid together?

Codecorrect says that 92250 is "mutually exclusive to code 92135 but a modifier is allowed in order to differentiate between the services provided."

Does anyone know what the circumstances are that would allow you to use a modifier? Which modifier?

Thanks

ophthalmology

The National Correct Coding Initiative treats fundus photography (92250) as mutually exclusive with 92135. This means that you will probably be paid for the fundus photos instead of the scanning laser if both are performed on the same day.
92250 is a unilateral or bilateral code
Code 92135 is a unilateral code (RT or LT).
Example: the patient presents with diagnosis of glaucoma and diabetic retinopathy. Monitor the glaucoma’s progression with a scanning laser test (92135-59, RT or LT) you must also link a glaucoma diagnosis, such as 365.11 (Primary open-angle glaucoma), to code 92135. Code the diabetic retinopathy with codes, such as 250.5x and 362.05 (Moderate nonproliferative diabetic retinopathy), link to CPT to code 92250.

ophthalmology

When I read modifier 59, it states different sites, but we are in the same site?

Ophthalmology question

We have billed a 92250 and a 92135 on the same day with the same dx with a modifier 59 and have recieved payment. If we have a patient that lives far away, or an older patient in which it would be a hardship for the patient to come back to the office, we use the modifier.

re: Ophthalmology question

Can you bill right and left eye separately for 92250?

re: Ophthalmology question

I would say no. In 92250 it says both eyes are photographed.

re: Ophthalmology question

Unfortunately no.