Ophthalmic Coding: Need input

ceskourup

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Local Chapter Officer
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Anchorage, AK
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Hello. Have question about OCT (Optical Coherence Tomography) 92135 RT & LT. I have Medicare paying for them, no problem as long as the dx is right. BUT I am having problems with getting BCBS - Wal-Mart to pay. They claim that "the service is denied because it is deemed experimental/investigational by the payer." Can someone shed some advice on how to argue this? I'm open to trying anything. (When I called, I got the same answer and she could elaborate)

Thanks!
 
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eferris

Contributor
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Dont know if you ever found an answer for your question. But in my experience Blue Cross Blue Shield-Walmart is very tricky to work with. They have very limited benefits and pay for many things. When i get a denial like that, its generally diagnosis driven and it means that the diagnosis used isnt on their medical policy as a covered diagnosis. i would try to see if you can get them to send you a copy of their medical policy for that code and see where that goes. Hope that helps.
 
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