Is it wrong to bill medical when patient seen for routine eye exam?

[cherylml]

Patient seen for yearly annual eye exam. No concerns noted, myopia bilateral, and History of retinopathy of prematurity. 92004 and 92015 were billed to the patients medical insurance BCBS. Patient also has vision coverage through another payor. Is this ok to bill the medical insurance or do we HAVE to bill the vision coverage since we are billing for vision services. Diagnosis billed is Z03.89. We are an upstate NY provider.

Any thoughts (and references if possible) are greatly appreciated!

 

[natashalage]

Hello, I am not an expert but I do code eye services; here are my thoughts. I would change dx. The dx Z03.89 is encounter for obs for other suspected dx and conditions ruled out. But you can use for example Z01.00. and add myopia H52.13 and history Z8669 or if prematurity is still affects/present, then code it as present. Our providers are using eye codes and e/m interchangebly but i read CPT Assistant article that usually e/m is used for medical treatment. We bill both types depending what MD drops in the charge session but I level it.