Wiki 99203 + 92071?

[jenna_m]

Hi,

I billed CPT code 92071 (fitting of contact lens for tx) with code 99203 to Medicaid recently and it was denied saying local carrier determination does not support the ICD-10/CPT combination billed.

Can these codes not be billed together?

 

[lgardner]

Hi,

I billed CPT code 92071 (fitting of contact lens for tx) with code 99203 to Medicaid recently and it was denied saying local carrier determination does not support the ICD-10/CPT combination billed.

Can these codes not be billed together?

you state it was denied because of the "ICD-10/CPT combination billed."
what was the ICD-10 code used?

 

[jenna_m]

you state it was denied because of the "ICD-10/CPT combination billed."
what was the ICD-10 code used?

Hi, the dx was S05.00XA. Thanks!

 

[Evelyn Kim]

Did you include any modifiers on the CPT codes? check out the TMPPM Vision and Hearing Services handbook, November 2022 section 4.3.8.3:
"Modifier LT or RT must be included on the claim to identify the eye on which the service was performed".

https://www.tmhp.com/resources/provider-manuals/tmppm

 

[jenna_m]

Did you include any modifiers on the CPT codes? check out the TMPPM Vision and Hearing Services handbook, November 2022 section 4.3.8.3:
"Modifier LT or RT must be included on the claim to identify the eye on which the service was performed".

https://www.tmhp.com/resources/provider-manuals/tmppm

Yes, I submitted the claim with the modifier RT.

 

[Cheezum51]

You have used an "unspecified" ICD-10 code. You should use a code which specifies the eye involved, in addition to the proper modifier.
Tom Cheezum, OD, CPC, COPC

 

[jenna_m]

You have used an "unspecified" ICD-10 code. You should use a code which specifies the eye involved, in addition to the proper modifier.
Tom Cheezum, OD, CPC, COPC

Thank you, I'll try that!