Wiki Tear film analysis 83861

[ajimenez]

Has anyone been having a problem getting the tear film analysis 86831 paid? I have been going round and round with this code for ever and need some answer please? I have put modifiers QW, RT, LT, 76 and 91 not all together of course to no avail. Can anybody help me with this?

Thanks Annette

 

[curiousgeorge]

When I file for the 83861, I use the QW and RT and LT modifiers. There are some insurances that do not pay for these services and some insurances will only pay for one eye. If filing to United Healthcare and or Tricare South, only bill one line item with no modifiers and change the units to 2. I do not believe Bluechoice pays for this service. Hope this helps.

Also, make sure your CLIA number is on your claim forms. Insurances will not pay if this number is not on your claim form.

Sincerely,

Becca

 

[ajimenez]

yes our CLIA is on the claims as far as I know but we get denials from all insurance I don't think that anyone has paid for this service. also when I enter 2 units I get an error of this could be a duplicate. I have tried with the QW no RT and Lt on one line and still gets denied. I have tried without the QW and still denied I don't know what else to do.

Annette

 

[mrsjehu]

This one is a major pain. We too have been having issues, here is what has worked for us.
1. you need to make sure that your ordering Dr. is in the referring Dr. box.
2. CLIA # set up and in the correct spot.
3. For Medicare/Medicare advantage plans 83861 QW/ eye mod (RT/LT) 2 line items.
3. Commercial plans 83861 2nd line 83861 - 51

If you have additional questions/issues feel free to PM me.

 

[ajimenez]

Thanks mrsjehu for your answer. According to my RC it's not the commercial payors that are not paying it's the federal payors some don't recognise the QW, RT, and Lt modifiers so I have no idea how to bill it to them and also on a side note we are PBC provider based clinic is there a different on that also? should the facility be billing this only?

Thanks Annette