Wiki Medicare Denial as routine

[missyah20]

Good Afternoon,
I am billing the anesthesia charge for a patient that had an LRI done for Post-operative astigmatism(this is the dx per the op report). Medicare has denied this stating that this service was performed for routine screening purposes. This was billed with diangosis code 367.20. Is there a different dx code that we should have used to bill with? Thanks!

 

[dkeown]

Missy,
You don't state which code you are billing (00140?) nor which procedure the surgeon performed (65772/65775) so I'm only guessing, but according to my information (Coding Companion for Ophthalmology) the approved dx for this type of procedure would be 362.21, 367.22, 996.51, V42.5 or V45.69.

Hope this helps.

David Keown, CPC, OCS

 

[luismarin1]

367.20 falls under "routine" when billed through medical ins... 367.20 should b billed through pt's vision plan since it falls under "routine".

mostly all 367 catg fall under routine only... depending on payer guidelines. u need a "medical diag" to bill mcr for those services, IMO.

 

[vpcats]

Good Afternoon,
I am billing the anesthesia charge for a patient that had an LRI done for Post-operative astigmatism(this is the dx per the op report). Medicare has denied this stating that this service was performed for routine screening purposes. This was billed with diangosis code 367.20. Is there a different dx code that we should have used to bill with? Thanks!

Post-surgical astigmatism , and either:

A. �� Regular astigmatism >3.5D (367.21) - also check one or more as applies:
�� Status post cataract surgery (367.21,V45.61)
�� with IOL (367.21, V45.61, V43.1)
�� Other eye or adnexa surgery (367.21, V45.69)
B. �� Irregular astigmatism
- also check one or more as applies:
�� Status post cataract surgery (367.22, V45.61)
�� with IOL (367.22, V45.61,V43.1)
�� Other eye or adnexa surgery (367.21, V45.69)