SCODI code edits and denial rules (92132, 92133, 92134)
This document governs coding edits and denial rules for ophthalmology SCODI CPT codes (92132, 92133, 92134) for BlueCross BlueShield of Tennessee claims, specifying when units will be denied based on diagnosis and frequency.
No material clinical or coverage changes in this revision.
SCODI Denial and Frequency Rules
SCODI denial and documentation criteria
Frequency- and diagnosis-based denial rules and documentation requirements for SCODI CPT codes (92132, 92133, 92134).
Denial rules (apply when true)
- 92134 (retina): deny additional units when billed more than once per year for any diagnosis other than glaucoma or retinal disease.
- 92133 (optic nerve): deny additional units when billed more than one unit per year for any diagnosis other than glaucoma.
- 92133 or 92134: when the diagnosis is glaucoma, deny additional units beyond two units per year.
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