Optometry Coding & Billing Alert

Published on Sun Jul 02, 2006 PDF

 Tip: Don't forget to attach all supporting documentation

The expression -actions speak louder than words- doesn't apply when you-re appealing a claim. Correct and effective wording of your appeal letter is crucial.
 
Rest assured you-ve done all you can to win your appeal by adapting this appeal letter template:

Dear [director of claims]:

 
Our claim for E/M service rendered to your covered policy holder [patient name] has been incorrectly denied. An Explanation of Benefits was received on [date] with a denial reason of [denial reason]. 
 
[Patient name] presented to our office for an office visit on [date of service]. A patient workup of [history, exam and medical decision-making] was provided, with a finding of [describe finding]. A medically appropriate and necessary [describe diagnostic procedure or surgery] was performed following this finding. Attached, please find documentation to support these services.
 
Our claim was correctly submitted with CPT Codes [992xx-25] and [procedure code]. This E/M service is not bundled into the global procedure/surgery fee. In fact, the service was a significant, separately identifiable service provided above and beyond the procedure and submitted with the appropriate modifier. Therefore, this appeal is provided to reprocess this claim for immediate payment.
 
Thank you for your assistance and immediate response.

 [Signature line]

Attach: Office visit note
  Surgery/Procedure note
  Copy of original claim
  Copy of EOB