CPT code 92235 is used for billing a fluorescein angiography procedure, either unilateral or bilateral.
CPT code 92235 is used to document a fluorescein angiography procedure, either unilateral (affecting one eye) or bilateral (affecting both eyes). This diagnostic test involves the injection of a special dye, fluorescein, into the bloodstream. The dye highlights the blood vessels in the back of the eye so they can be photographed to help diagnose conditions affecting the retina. This procedure is crucial for identifying and managing conditions such as diabetic retinopathy, macular degeneration, and other disorders affecting the retinal vasculature.
For CPT code 92235, which is used for fluorescein angiography (either unilateral or bilateral), several modifiers may be applicable depending on the specific circumstances of the billing and the requirements of the payer. Here is an ordered list of common modifiers that might be used with this CPT code and the reasons for each:
1. -26 Professional Component: This modifier is used when only the professional component of the procedure is being billed because the service was performed in a facility that provided the equipment and technical support. The -26 modifier indicates that the billing is for the physician's analysis and interpretation only.
2. -TC Technical Component: Conversely, this modifier is used when only the technical component of the procedure is being billed. This situation occurs when the physician owns the equipment but does not personally perform the procedure. It is used to bill for the use of equipment and technical staff.
3. -50 Bilateral Procedure: Although CPT code 92235 can be reported as either unilateral or bilateral, the -50 modifier is used when the provider needs to specify that the procedure was performed on both eyes during the same session. This modifier helps in ensuring appropriate reimbursement for bilateral procedures.
4. -LT Left Side and -RT Right Side: These modifiers are used to specify which eye was treated if the procedure was not performed bilaterally. -LT indicates the procedure was performed on the left side, and -RT indicates it was performed on the right side.
5. -59 Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This might be applicable if fluorescein angiography (92235) is performed in conjunction with another eye procedure that normally would be bundled together.
6. -76 Repeat Procedure by Same Physician: This modifier is used if the fluorescein angiography needs to be repeated in the same session by the same physician, perhaps due to initial inadequate results or technical issues.
7. -77 Repeat Procedure by Another Physician: Similar to -76, but used if the procedure is repeated by a different physician on the same day.
8. -22 Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to complications or special circumstances that make the procedure more complex.
Each of these modifiers serves to provide specific details that can affect billing and reimbursement. It's important to use the correct modifier to ensure accurate and efficient processing of claims. Always check with specific payer guidelines as the applicability and acceptance of modifiers can vary.
CPT code 92235, which refers to fluorescein angiography unilateral or bilateral, is generally reimbursed by Medicare. This procedure is commonly used in the diagnosis and management of various retinal conditions, and as such, it is recognized as a necessary diagnostic test under many circumstances.
The reimbursement for CPT code 92235 can vary based on geographic location and the setting in which the service is provided (e.g., outpatient hospital, physician’s office). To determine the specific reimbursement amount, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or through Medicare Administrative Contractors (MACs) that manage claims and payments in specific regions.
Providers should also be aware that documentation and medical necessity play crucial roles in ensuring that the service is covered and reimbursed. Proper coding, including the use of appropriate modifiers if applicable, is essential to facilitate accurate billing and optimal reimbursement.
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