Billing Post Op Cataract to Medicaid

CortneyDhein

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Hey everyone! I have a quick question regarding post op cataract claims and Medicaid. We have received 3 denials from Medicaid stating that since we are an Optometrist, the 66984 procedure code is not valid. Does anyone know where I can find what procedure codes are accepted by Medicaid for Optometry? Thanks in advance!
 

miracle01

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Hey everyone! I have a quick question regarding post op cataract claims and Medicaid. We have received 3 denials from Medicaid stating that since we are an Optometrist, the 66984 procedure code is not valid. Does anyone know where I can find what procedure codes are accepted by Medicaid for Optometry? Thanks in advance!

66984 is a cataract surgery code. You would only use that code for the actual surgery using the correct POS. Post op care is usually included in the surgery reimbursement but maybe there is an office visit code that would apply, I'm not sure about that.
 

Cheezum51

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You have to be sure the surgeon's office is using the 54 modifier and that you are using the 55 modifier, as mentioned by a previous poster. You also have to be sure that your care dates coordinate properly with what the surgeon reports.

Tom Cheezum, O.D., CPC
 
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Was this a co-managed case? If so you need modifiers and the number of days you are covering for the post op care.
66984-55 with the days would be appropriate to report. The doctor who did the surgery reports with a modifier as well indicating he did the surgery only and a couple of days of follow up care.
Hope this helps.
 
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