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Ophthalmology Coding

  1. #1
    Default Ophthalmology Coding
    Medical Coding Books
    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 ?

  2. #2
    Default
    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?

  3. #3
    Default
    Yes, duplicate, even though it's LT & RT. They said to send a redetermination letter with medical records for review.

  4. Default
    Quote Originally Posted by cpccoder2008 View Post
    Yes, duplicate, even though it's LT & RT. They said to send a redetermination letter with medical records for review.
    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 by vpcats; 04-01-2010 at 01:45 PM.

  5. #5
    Default
    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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