Wiki Medical biller,cpc ophthalmology

[cadp430]

I have been getting denied by medicare and other ins for cpt 76514 corneal pachymetry with dx code 365.00. Per lcd this dx is payable but it's been denied as not medically necessary. Can anyone help me as to why it's not getting paid.

 

[JNBagley]

I have had them deny by Medicare for medical necessity because they are only allowed to be billed once per lifetime (I believe it's lifetime)...not just because of DX.

 

[mzkandyd]

It is a once in a lifetime code. Therefore you would need to have an ABN from the patient. Our office automatically gets one because you can't tell the frequency on the pachy until medicare has processed the claim. Once of my 3rd party payers does the same thing. The ABN will protect you and the patient.

I have had them deny by Medicare for medical necessity because they are only allowed to be billed once per lifetime (I believe it's lifetime)...not just because of DX.