MarkG01
Networker
Looks like the previous coder/biller was using 92015 with Dx of V72.0. Is this appropriate I an unable to find a definate answer. People in the office say to bill patient after we receive denial.......
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Wiki 92015 with v72.0
- Thread starter MarkG01
- Start date
smarcolina
Networker
92015 is not usually paid by most insurance companies. We bill with the diagnosis code that was applied to the visit. If it is a routine visit then we use the V code.
Sharon
Sharon
Do you bill the vision or E/M code w/ 92015?
Some medical insurances will pay the 92015 if it's for a medical reason ex: diabetes.
Some medical insurances will pay the 92015 if it's for a medical reason ex: diabetes.
rhotonscott
Networker
???
Where is the medical necessity in performing a level 5 service with a V72.0 examination of eyes and vision? Was there a sign and/or symptom necessitating a 12 bullet eye exam and a high MDM? I know the History component Isn't going to be comprehensive-IT'S AN EYE PROBLEM! Now if there was a lot of data, rule-outs, a severe exacerabation, the possibility of losing an eye/vision necessitating immediate intervention THEN I might agree.
However, all hope is not lost. If the patient has ongoing Diabetic Retinopathy, cataracts, congential disorders affecting the eyes and the provider writes at least some form of history/eval-then you can use eye codes depending on the exam elements- a full SLE will usually get you an intermediate code and a full SLE, dilated exam with drops listed, ocular motility and gross visual fields will get you a comprehensive code. Be careful though and read the requirements for using these codes in the CPT book. (ie the comprehensive codes requires that some form of treatment/diagnostic testing be done at the visit) You may have to default to low E/M levels if criteria aren't met. Better the providers are mad and have to be educated properly on medical necessity and documentation requirements then an auditor come in and fine you for not coding correctly.
Where is the medical necessity in performing a level 5 service with a V72.0 examination of eyes and vision? Was there a sign and/or symptom necessitating a 12 bullet eye exam and a high MDM? I know the History component Isn't going to be comprehensive-IT'S AN EYE PROBLEM! Now if there was a lot of data, rule-outs, a severe exacerabation, the possibility of losing an eye/vision necessitating immediate intervention THEN I might agree.
However, all hope is not lost. If the patient has ongoing Diabetic Retinopathy, cataracts, congential disorders affecting the eyes and the provider writes at least some form of history/eval-then you can use eye codes depending on the exam elements- a full SLE will usually get you an intermediate code and a full SLE, dilated exam with drops listed, ocular motility and gross visual fields will get you a comprehensive code. Be careful though and read the requirements for using these codes in the CPT book. (ie the comprehensive codes requires that some form of treatment/diagnostic testing be done at the visit) You may have to default to low E/M levels if criteria aren't met. Better the providers are mad and have to be educated properly on medical necessity and documentation requirements then an auditor come in and fine you for not coding correctly.
Pam Warren
True Blue
I think you've confused 92015 with the E&M code 99215. The OP was asking about determination of refractive state.