SEP 09, 2021
Unbundling 92250 with 92133 or 92134
Question: Our practice received an audit request for 10 records. They are all times when we’ve unbundled CPT code 92133 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve or 92134 retina from 92250 Fundus photography with interpretation and report. We have heard so many opinions on unbundling. As we prepare best or worse case scenarios, when can/should you unbundle these tests?
Answer: The answer to when to unbundle 92250 with 92133 or 92134 is only when the specific payer publishes the unique conditions — in writing. It is important not to take one payer’s rule or a perception of a rule and apply it to all payers. This bundling edit has been in place since January 1, 2011. While CCI assigns the bundle an indicator of “1” it also states these are mutually exclusive procedures.