Wiki use of dx V43.1

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mjaponis345

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Our opthomology office seen a patient for their yearly exam and billed 92014 with dx V72.0. The insurance denied and now I'm being asked to rebill using dx V43.1. Patient had cataract surgery in 2012, I don't feel this is a valid dx to use for the visit. I cannot find any documentation online that this dx can or can't be used. Any information is greatly appreciated!

Thank you
 
mjaponis345 said:
Our opthomology office seen a patient for their yearly exam and billed 92014 with dx V72.0. The insurance denied and now I'm being asked to rebill using dx V43.1. Patient had cataract surgery in 2012, I don't feel this is a valid dx to use for the visit. I cannot find any documentation online that this dx can or can't be used. Any information is greatly appreciated!

Thank you
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The V43.1 is a secondary only dx code. You are correct in your billing . Many commercial payers do not provide preventive vision coverage unless the patient has a vision plan.
 
If the patient doesn't have a vision plan, typically insurances will deny the v72.0. However, the patient has a medical condition that is part of the reason for the visit, checking the implanted lens. I absolutely would use the v43.1 and it can be a primary diagnosis.
 
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