92015 but no orders

[jessmilquet]

Can someone help me. I have some providers that are completing a refraction or manifested refraction and have everything documented in the patients record. The provider is either deleting the order for the refraction or not putting an order in for the refraction at all. It is for all insurances. Does there need to be an order in the patient record to be able to bill for the refraction? And if so, can I not bill for the refraction if there is no order but it is in the medical record as being completed?

Thanks for any help!

 

[Cheezum51]

Refractions

You don't really need an "order" for a refraction. It isn't really what's considered "special" testing.

Your office needs to set a fee just for the refraction, when it's done. Medicare, nor hardly any other major medical insurer, pays for the 92015 refraction code. Therefore, you should collect the refraction fee, along with any copays, while the patient is in the office.

We always bill the 92015 so, if the patient questions us having collected the fee at time of the exam, the patient will see the non covered service on the EOB they get. If by chance the insurer does pay for the 92015, which rarely ever happens, then refund the fee to the patient.

ALWAYS collect for the 92015 when they are in for their exam. If you don't you'll have lots of trouble collecting it later.

 

[opiecpc]

92015 & 92250

Hello, Am new to coding eye clinic visits. On the 2 CPT procedures would they be Technical Components or Professional Component. Thank You.

92015-Refraction
92250-Fundus Photography

 

[Cheezum51]

The 92015 isn't broken down into technical and professional components whereas the 92250 is. However, when you bill the 92250, if the photos are done in your office and the doctor "interprets" them, you don't have to bill separately for the two components. Just billing for the 92250 by itself indicates that both components were done in the same office.

If your office is taking the photos for another office and you simply send the pictures to the other office for that doctor to evaluate and interpret, then you would bill 92250-TC and the doctor's office would bill for the professional component.

Tom Cheezum, O.D., CPC