CPT Code 92134

(2022) CPT Code 92134 Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 92134 is used for Ophthalmological examination and evaluation procedures, which the American Medical Association maintains. Unilateral ocular diagnostic tests are those in which only one eye or side is tested, while bilateral tests are those in which payment includes both eyes or sides. Therefore, the CTP code 92134 is used for unilateral or bilateral retina examination testing.

CPT Code 92134 Description

Descriptors in the CPT format are preceded by a capital letter. If a semicolon appears after a description, all information in that description is deemed part of the description in any subsequent, lowercase, indented code.

An eye doctor uses computerized imaging of the retina in the back of the eye to look for signs of disease. Then, analyzing and writes up his findings. One or both eyes can be operated on with this procedure.

CPT code 92134 for the retina was provided as a CPT description during the topic of “unilateral or bilateral. It does not matter if one or both sides are evaluated when using a bilateral operation indicator and the term “unilateral or bilateral.” It is only billed once. Modifier 52 should not be used when testing only one side. 

Because the treatment for age-related macular degeneration relies on OCT results, caution should be exercised when billing fundus photography instead of OCT. Anterior segment CPT code 92134 -Scan Computerized Ophthalmic Diagnostic Imaging with report and interpretation; retina

92134 cpt code

Retinal disease is the most prevalent cause of severe and irreversible visual loss. In addition, macular degeneration is a condition that can be diagnosed and treated using these technologies. 

The use of these imaging modalities is essential for determining the efficacy of therapy and whether to continue or discontinue treatment. Bilateral Retina One exam every two months is the limit for those diagnosed with a primary ophthalmological diagnosis of retinal sickness. 

Those battling macular degeneration or diabetic retinopathy might have one eye examined every month while on treatment. The Ganglion Cell Analysis – CPT code 92134 is used to isolate the ganglion cell layer.

92250 and 92133 or 92134 cannot be performed on the same patient simultaneously, as they are both fundus photography procedures. There is a 2017 CMS policy document that states:

Fundus photography and scanning ophthalmic computerized diagnostic imaging (CPT codes 92132, 92133, and 92134) are mutually exclusive when diagnosing fundal sickness.

92134 cpt code description

However, both treatments are medically necessary and appropriate for the ipsilateral eye in some cases. Therefore, modifier 59 should be added to CPT code 92250 in these circumstances.

There has been a rapid rise in optical coherence tomography (OCT) in optometry. Therefore, it was decided in 1999 that all ocular OCT procedures would be categorized under the broad, non-anatomically. 

Three new codes, each with anatomically unique rules and applications, took the place of 92135 in January 2011. There are two types of post-segment computerized visual diagnostic imaging: unilateral and bilateral. 

The National Correct Coding Initiative (CCI) was updated with these new codes, highlighting areas of disagreement when these tests were performed on the same day as other commonly performed procedures or with each other.

CPT Code 92134 Billing Guidelines

92133 or CPT code 92134, with any relevant modifiers, should be used to report OCT (e.g., 26, TC). There are two CPT codes for procedures with CPT codes 92133 and 92134 CPT code guidelines that state that you cannot record 92133 and 92134 simultaneously.

 To properly document the patient’s health and the necessity for over-the-counter medication, use an ICD 9 code. Not everyone should be subjected to an optical disc examination as a screening method.

Data from the patient’s examination must be used to prove the testing’s medical necessity. If there are no associated signs, symptoms, diseases, or injuries, this service will be refused as non-covered.

92134 cpt code definition

Incorrect or incomplete ICD-9 coding by physicians will result in their services being refused. Three new codes (92132, 92133, and CPT code 92134) have been introduced to replace CPT 92135, a significant change for ophthalmic and optometric practitioners alike.

 It was not a surprise to me. More and more people are using SCODI to test their eyes, and this trend is predicted to continue once per-eye pricing is discontinued in 2011. In addition, there is a surge in post-payment audits for earlier claims due to aggressive billing, specifically the abuse of modifier -59 with fundus photography. 

Payments will be reduced due to the change in the description to “unilateral or bilateral.” In addition, a new policy for each CPT code will be implemented, clarifying coverage and payment requirements for various medical conditions.

Providers will receive the same payment regardless of whether only one side is inspected if a code indicates “unilateral or bilateral.” Medicare uses the MPFSDB’s bilateral surgical indicator to calculate payment without “unilateral or bilateral indication.”

The CPT code 92134 indicates “unilateral or bilateral,” suggesting that the physician is paid the same amount whether one or both eyes are evaluated.

On the other side, CPT code 76512 reads B-scan ophthalmic ultrasonography, diagnostic (with or without superimposed no quantitative A-scan). Although it does not say “unilateral” or “bilateral,” this code is paid according to the MPFSDB indicator. 

Code indicates that the Medicare charge schedule permitted payment for that code will be paid to each party.

SCODI’s fundus photo bundles go back to the very beginning of the code’s development. Then, many practitioners were billing for both tests but not doing separate fundus pictures; they were just included in the SCODI test (a recreation of the optic nerve). 

Unbundling them is not permitted unless your Medicare contractor says so. Florida’s First Coast Service Options is working on a draught policy to address this issue. 

The NCCI bundles fundus photographs (CPT code 92250) with OCT for the retina (CPT code 92134). For fundus pictures, the national average cost is $73.38; for OCT retina, it is $44.51.

cpt 92135

CPT Code 92134 Modifiers

One of the biggest changes in ophthalmology and optometry is CPT 92135’s abolition and three new successor codes (92132, 92133, and CPT code 92134). It was not a surprise to me. The use of SCODI (a replication of an optic nerve) testing has grown significantly in the recent decade.

 When per-eye billing was phased out in 2011, it was expected to rise beyond the forecast reduction. In addition, post-payment audits for past claims are expected to rise due to aggressive billing, particularly the misuse of modifier -59 with fundus photography.

The change in the description to “unilateral or bilateral” will result in a reduction in payments. In addition, there will be a new policy for each CPT code defining coverage and reimbursement conditions for various conditions.

Single-eye or double-eye testing costs the same amount of money. Unlike the new procedure codes (92132, 92133, and 92135), which pay SCODI for both sides, the old procedure codes (92135) only pay SCODI once for both sides. 

When the test is performed bilaterally, the cost is cut in half. There is only one charge, regardless of whether one or both eyes are tested. To simplify things, SCODI is now paid once rather than twice for both sides under Procedure Codes 92135 and the new codes (92132, 92133, and 92134).

 When the test is performed bilaterally, the cost is cut in half. The cost is the same whether testing is done on both eyes. The new CPT codes (92132, 92133, and CPT code 92134) only pay SCODI once instead of the two payments under the old CPT code (92135).

 If both ears are examined, the expense is reduced by roughly half. Whether you get one or both eyes examined, the price remains the same. In contrast to CPT codes 92132, 92133, 92134, and 92135, SCODI is now paid once instead of twice. 

Reimbursement

Medicare and other third-party payers cover SCODI-P scanning, but only to the extent that Medicare’s reimbursement guidelines allow; other third-party payers generally agree.

In addition, for SCODI-P to be covered by Medicare, it must be used in conjunction with the management and treatment of an established medical condition. 

No insurance will pay for the photos taken as a baseline to record the eyes’ health or as a preventative measure to screen for disease (even if the disease is identified). As an added precaution, tests performed for reasons that are not covered by the state’s insurance plan are not reimbursed. 

All candidates are for glaucoma, macular degeneration, and other posterior segment diseases. There is a wide range of policy differences among the various payers.

Example

Consider fundus photography, which is done exclusively on one eye. Due to the lack of a unilateral or bilateral descriptor in CPT code 92134, payment is conditional on both sides being evaluated.

The service is therefore regarded as limited if only one side is examined. The modifier 52 is omitted from the descriptor when the terms “unilateral” or “bilateral” exist.

When discussing “unilateral or bilaterally,” the CPT specification for OCT (92134) for the retinal was included. I have been examined when using a bilateral surgery indication of the retina and the term “unilateral or bilateral.” Then the CTP code 92134 is used for the patient.

Modifier 52 should not be used when only one side has been tested. OCT is the medically essential procedure in treating age-related macular degeneration, not fundus photography. This should be considered when billing for fundus images instead of OCT.

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