CPT code 92273 is used to bill for a full field electroretinography with interpretation and report.
CPT code 92273 is designated for a specific type of diagnostic test known as a full-field electroretinography (ERG) with interpretation and report. This procedure involves measuring the electrical response of the patient's retina to light stimuli to assess the function of the retina. The test is crucial for diagnosing various retinal conditions. The inclusion of "interpretation and report" indicates that the healthcare provider will analyze the results and provide a detailed report based on the findings from the ERG.
For CPT code 92273, which is used for full field electroretinography (ERG) with interpretation and report, several modifiers may be applicable depending on the specific circumstances of the service provided. Here is an ordered list of common modifiers that could 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 service (interpretation and report) is provided by the physician, and the technical component is provided by another entity.
2. -TC (Technical Component): This modifier is applied when only the technical component of the ERG test is provided, and the interpretation and report are handled separately.
3. -LT (Left Side) and -RT (Right Side): These modifiers are used to specify services performed on the left or right eye, respectively, if only one eye is tested.
4. -50 (Bilateral Procedure): This modifier is used when the ERG test is performed on both eyes during the same session.
5. -22 (Increased Procedural Services): This modifier may be used if the service provided is substantially greater than typically required, which should be documented in the patient’s medical record.
6. -52 (Reduced Services): Applied when the service provided is less than what is usually required for the complete procedure. This might be relevant if only part of the ERG test is performed.
7. -59 (Distinct Procedural Service): This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day.
8. -76 (Repeat Procedure by Same Physician): This modifier is used if the test needs to be repeated in the same session by the same physician.
9. -77 (Repeat Procedure by Another Physician): Used if the test is repeated by a different physician on the same day.
10. -91 (Repeat Clinical Diagnostic Laboratory Test): In the context of ERG, this modifier might be used if the test is repeated to confirm initial findings or due to an error in the initial test.
Each of these modifiers serves to provide additional information to payers about the circumstances under which the ERG was performed, ensuring appropriate reimbursement and avoiding billing errors. It’s important for billing and coding professionals to apply these modifiers correctly based on the specific details of how and where the service was rendered.
CPT code 92273, which pertains to full field electroretinography (ERG) with interpretation and report, is a procedure that can be reimbursed by Medicare. However, the reimbursement for this code can vary based on geographic location and the specific Medicare Administrative Contractor (MAC) policies in place.
To determine the exact reimbursement amount for CPT code 92273, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) lookup tool available on the Centers for Medicare & Medicaid Services (CMS) website. This tool provides detailed information on reimbursement rates based on the provider's locality.
Additionally, it's important for providers to verify coverage details with their local MAC, as there may be specific documentation requirements or limitations on the use of this code depending on the clinical indications and necessity of the procedure in individual cases.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to scrutinize contracts and identify discrepancies down to specific CPT codes, such as 92273 for full field erg w/i&r, RevFind ensures that each claim is fully compensated according to your payer agreements. Schedule a demo today to see how RevFind can help secure the payments you are entitled to from every individual payer.
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