Wiki 92250 Fundus photography

[primarymedbilling@yahoo.com]

Medicare denied my claim 92250-52 with remark MA130-claim lacks info. correct and resubmit. The doctor coded with modifier 52 because he only performed test on one eye and code is for bilateral. I am having a hard time figuring out what else they may want. The LCD policy L26810 has been retired for Oklahoma and when you search Novitas it brings up a current draft LCD policy for IDTF (Independ. Diag Testing Facilities). Does anyone know if they are wanting another modifier in addition to 52 such as LT or RT, or possibly AF to indicate speciality physician?

 

[kvangoor]

They might need the comments in box 19, that is what I was missing on some of my claims. WPS is my carrier and here is a link to the modifier 52 fact sheet. At the bottom it lists the other requirements.
http://www.wpsmedicare.com/j5macpartb/resources/modifiers/modifier-52.shtml

 

[raver]

We add the RT/LT modifier, 52RT or 52LT

 

[fhromeo30]

I dont use 52 ever, and have only recently started using Rt/Lt after reading a coding update to Optom.

 

[monopoly222]

You Need to Make Sure BOX 17a and 17b.....

Medicare denied my claim 92250-52 with remark MA130-claim lacks info. correct and resubmit. The doctor coded with modifier 52 because he only performed test on one eye and code is for bilateral. I am having a hard time figuring out what else they may want. The LCD policy L26810 has been retired for Oklahoma and when you search Novitas it brings up a current draft LCD policy for IDTF (Independ. Diag Testing Facilities). Does anyone know if they are wanting another modifier in addition to 52 such as LT or RT, or possibly AF to indicate speciality physician?

Make sure for all diagnostic tests that your referring/ordering doctor for
Box 17a and Box 17b match the CMS file EXACTLY meaning name, including or excluding initials, or titles. CMS has a spreadsheet with all current doctors for with the exact filing for their name/NPI that CMS requires. If your claim doesn't match CMS files then Medicare will deny all your diagnostic tests.

Once you have correct their name to match CMS file then you can refile the claims and get paid for your diagnostic tests.

Hope that helps!!