• 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 Billing complete exams

Create Wiki
R

rbassett

Contributor
Messages
18
Location
Coeur d'Alene, ID
Best answers
0
I have been told that billing for a complete exam (92004/92014) more than once per year would be “upcoding” and could potentially be cause for an audit if used. One of the providers I code for is a retina surgeon. I review his notes for each exam and he is very thorough and almost always hits the criteria for a complete exam on every visit for a patient due to the high risk nature of the diseases his patients normally have. Am I okay to be billing 92014 on say a second or third visit, or would that be cause for alarm for payers? They want me to instead bill 92012 for every visit the rest of the year after a 92004/92014 is billed for a patient which I think is actually “undercoding.” At the very least I should be able to bill for a 99213 or 99214 if the criteria is met for those. Please let me know what you think.
 
I bill for a retina specialist as well and regularly bill the 92014 when documentation warrants it. I think it is appropriate to bill according to what is documented. Hope that helps.
 
rbassett said:
I have been told that billing for a complete exam (92004/92014) more than once per year would be “upcoding” and could potentially be cause for an audit if used. One of the providers I code for is a retina surgeon. I review his notes for each exam and he is very thorough and almost always hits the criteria for a complete exam on every visit for a patient due to the high risk nature of the diseases his patients normally have. Am I okay to be billing 92014 on say a second or third visit, or would that be cause for alarm for payers? They want me to instead bill 92012 for every visit the rest of the year after a 92004/92014 is billed for a patient which I think is actually “undercoding.” At the very least I should be able to bill for a 99213 or 99214 if the criteria is met for those. Please let me know what you think.
Click to expand...

Depends on the patient's insurance: Kentucky Medicaid and EyeMed (to name a few) will only allow one complete exam per calendar year. Other carriers vary as to what they will allow.

David E. Keown, CPC, OCS
 
I just found on Medicare's mutually exclusive edits spreadsheet that 92014 is allowed once per 3 day period!
I also think some of the confusion comes from the fact that usually you can bill one 92014 with a VISION dx per year to vision plans.
 
You must log in or register to reply here.
Top