medicare modifier for fundus photos?

[k12311997]

I'll be honest I don't know what any of the modifiers mean I've just used what we always used, however I just got a bunch of denials for inappropriate modifier for photos. We used YR. Anyone know what should be used? I seem to remember Harry C. posting a link of modifiers but I can't find it.

Thanks

[jpways]

In most cases we don't use a modifier with Fundus Photos, the only time I can think of that you would use a modifier is 52 (reduced services) with either LT or RT (depending on the eye), if you are taking monocular photos. Here is a page that has the modifiers, along with some common usage modifiers with ophthalmic procedures:
http://chppm-www.apgea.army.mil/doem/coding/modifiers.aspx

After reading over the article again there is another modifier you may use and that is TC, for Technical component. You use this code when the technician, and not the doctor, is interpreting the results of the photo.
Just to let you know the YR modifier is no longer active (I assume because it was replaced by TC).

[harry888]

Fundus photos is a bilateral procedure, so no modifier unless only one eye is done.

If only one eye, use modifier 25 for reduced services.

Harry

[Uncle Double]

After reading over the article again there is another modifier you may use and that is TC, for Technical component. You use this code when the technician, and not the doctor, is interpreting the results of the photo.
Just to let you know the YR modifier is no longer active (I assume because it was replaced by TC).

I think you might have meant to say TC means when the technician takes the photo and the Professional Component is when the doctor interprets the photo (which can be billed at a later office visit)

From the article:
" CODES WITH TECHNICAL AND PROFESSIONAL COMPONENTS – The following procedures may be run by a technician absent the doctor in which case the TC (Technical component) modifier is applied to the code. When the doctor sees the patient on a separate visit to discuss results of the test the procedure is coded with modifier 26 (professional component). "

[k12311997]

thanks for your responses, with the YR we would put the Dr. as the referring provider.

the photos are taken by a tech and interperated by the Dr. the same visit.

1. If we use no modifier, Do we need a referring provider?

2. If we use TC, Do we need a referring provider?

I'd just be happy getting paid, but I'd like to do it the most proper way.

[jpways]

thanks for your responses, with the YR we would put the Dr. as the referring provider.

the photos are taken by a tech and interperated by the Dr. the same visit.

1. If we use no modifier, Do we need a referring provider?

We generally submit with the referring provider, though certain insurances (like Highmark, but we've only done this through NaviNet so I don't know if it's the method of submission or company policy) don't always require it.

2. If we use TC, Do we need a referring provider?

I would since the TC is just the photo (thank you for correcting my misintrepretation) itself but the insurance company would probably want to know who's ordering the procedure do they can match it up when the 26 comes through. But this may also be an insurance company to insurance company thing.

I'd just be happy getting paid, but I'd like to do it the most proper way.

I believe that is everyone's goal who submits insurance because the alternative is not a fun experience.

[DrJ2]

thanks for your responses, with the YR we would put the Dr. as the referring provider.

the photos are taken by a tech and interperated by the Dr. the same visit.

1. If we use no modifier, Do we need a referring provider?

2. If we use TC, Do we need a referring provider?

I'd just be happy getting paid, but I'd like to do it the most proper way.

I'm not sure who told you to use the YR modifier, but you guys need to buy a copy of AMA CPT book.

You don't need to use any modifier, just use the correct exam cpt code and photo cpt code along with an appropriate diagnosis for each procedure. You can find the linked diagnosis for each procedure on your medicare carriers web site.