MAY 23, 2022
Does the ICD-10 Code Trigger Multiple Procedure Payment Reduction?
Our office often bills 92242 and 92134 together on patients with moderate diabetic retinopathy with macular edema and retinal hemorrhages. We have heard that coding the same diagnosis for both tests will trigger a multiple procedure payment reduction, reducing the OCT reimbursement. Is it better to code different diagnosis (e.g., H35.63 and E11.3313)?
The multiple procedure payment reduction will apply regardless of the diagnosis attached. It applies to tests performed on the same patient on the same date of service. The test with the highest technical component (-TC) value is reimbursed in full, but the payment for the -TC for the second and subsequent tests is reduced by 20%. The reduction is automatic, you do not have to append any modifiers.