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Wiki Ophthalmology Coding

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cpccoder2008

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Since we don't have an Ophthalmology headline i'll post it here since i am referring to Medicare. For the past several weeks i have been denials on my ophthalmoscopy. I submit both with RT & LT on each one, with most of the time seperate diagnosis as well. Lately they have been paying one and deny the other as duplicate. Anyone else having this problem ?
 
I have not had any issues with Medicare regarding is code. I would call Medicare and ask. Is there a specific denial code associated with the denial?
 
cpccoder2008 said:
Yes, duplicate, :confused: even though it's LT & RT. They said to send a redetermination letter with medical records for review.
Click to expand...

You're billing 92225 (or 92226) LT and 92225 (or 92226) RT, each on a separate line? Each with its own diagnosis?
This shouldn't be getting denied as it is a unilateral procedure payable per eye (assuming there is medical necessity for each eye).

if you're billing a level 4 or 5 new patient E/M or level 5 follow-up E/M, they may request documentation to make sure your "ophthalmoscopy" is indeed a Indirect Extended ophthalmoscopy.

Medicare has rules for these codes.
 
Last edited:
Yes i'm billing with seperate dx and seperate lines. Provider relations states that it might have hit two seperate times causing it to deny for duplicate so just send a corrected claim letter and they will review it.
 
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