• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki use of dx V43.1

Create Wiki
M

mjaponis345

New
Messages
1
Best answers
0
Our opthomology office seen a patient for their yearly exam and billed 92014 with dx V72.0. The insurance denied and now I'm being asked to rebill using dx V43.1. Patient had cataract surgery in 2012, I don't feel this is a valid dx to use for the visit. I cannot find any documentation online that this dx can or can't be used. Any information is greatly appreciated!

Thank you
 
mjaponis345 said:
Our opthomology office seen a patient for their yearly exam and billed 92014 with dx V72.0. The insurance denied and now I'm being asked to rebill using dx V43.1. Patient had cataract surgery in 2012, I don't feel this is a valid dx to use for the visit. I cannot find any documentation online that this dx can or can't be used. Any information is greatly appreciated!

Thank you
Click to expand...

The V43.1 is a secondary only dx code. You are correct in your billing . Many commercial payers do not provide preventive vision coverage unless the patient has a vision plan.
 
If the patient doesn't have a vision plan, typically insurances will deny the v72.0. However, the patient has a medical condition that is part of the reason for the visit, checking the implanted lens. I absolutely would use the v43.1 and it can be a primary diagnosis.
 
You must log in or register to reply here.
Top