CPT code 92260 is for performing ophthalmoscopy with dynamometry, a diagnostic eye examination.
CPT code 92260 is designated for ophthalmoscopy combined with ocular dynamometry. This procedure involves the use of an ophthalmoscope to examine the interior of the eye while simultaneously measuring the pressure within the eye using ocular dynamometry. This combination is typically used to assess the blood flow and pressure in the eye, which can be crucial for diagnosing various eye conditions.
For CPT code 92260, which pertains to ophthalmoscopy/dynamometry, several modifiers may be applicable depending on the specific circumstances of the procedure performed. Here is an ordered list of potential modifiers and the reasons for their use:
1. -26 Professional Component: This modifier is used when only the professional component of the service (interpretation and report) is performed, and the facility provides the equipment and technical support.
2. -TC Technical Component: Use this modifier when only the technical component of the service is provided, such as the use of equipment and technical staff. The professional interpretation is billed separately.
3. -LT Left Side: Indicates that the service was performed on the left eye.
4. -RT Right Side: Indicates that the service was performed on the right eye.
5. -50 Bilateral Procedure: This modifier is used when the procedure is performed on both eyes during the same session.
6. -59 Distinct Procedural Service: This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day.
7. -76 Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated by the same physician on the same day to address a separate issue or a separate injury.
8. -77 Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day.
9. -22 Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required.
Each of these modifiers addresses specific billing and procedural nuances that may arise during the administration of ophthalmoscopy/dynamometry, ensuring accurate and precise billing and reimbursement practices.
CPT code 92260, which pertains to ophthalmoscopy/dynamometry, is typically reimbursed by Medicare. However, the reimbursement amount can vary based on the geographic location and the specific Medicare Administrative Contractor (MAC) policies. To determine the exact reimbursement rate, it is advisable for healthcare providers to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website or contact their local MAC. Additionally, providers should ensure that the documentation supports the medical necessity of the procedure to facilitate appropriate reimbursement.
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