Results 1 to 4 of 4

Medicare Denial as routine

  1. #1
    Default Medicare Denial as routine
    Exam Training Packages
    Good Afternoon,
    I am billing the anesthesia charge for a patient that had an LRI done for Post-operative astigmatism(this is the dx per the op report). Medicare has denied this stating that this service was performed for routine screening purposes. This was billed with diangosis code 367.20. Is there a different dx code that we should have used to bill with? Thanks!
    Missy Heuer CPC, CIRCC, CANPC

  2. #2
    Location
    Lexington Kentucky Chapter
    Posts
    105
    Default Medicare Denial as routine
    Missy,
    You don't state which code you are billing (00140?) nor which procedure the surgeon performed (65772/65775) so I'm only guessing, but according to my information (Coding Companion for Ophthalmology) the approved dx for this type of procedure would be 362.21, 367.22, 996.51, V42.5 or V45.69.

    Hope this helps.

    David Keown, CPC, OCS

  3. #3
    Location
    Nassau Central New York Chapter
    Posts
    51
    Default
    367.20 falls under "routine" when billed through medical ins... 367.20 should b billed through pt's vision plan since it falls under "routine".

    mostly all 367 catg fall under routine only... depending on payer guidelines. u need a "medical diag" to bill mcr for those services, IMO.

  4. Default
    Quote Originally Posted by missyah20 View Post
    Good Afternoon,
    I am billing the anesthesia charge for a patient that had an LRI done for Post-operative astigmatism(this is the dx per the op report). Medicare has denied this stating that this service was performed for routine screening purposes. This was billed with diangosis code 367.20. Is there a different dx code that we should have used to bill with? Thanks!
    Post-surgical astigmatism , and either:

    A. �� Regular astigmatism >3.5D (367.21) - also check one or more as applies:
    �� Status post cataract surgery (367.21,V45.61)
    �� with IOL (367.21, V45.61, V43.1)
    �� Other eye or adnexa surgery (367.21, V45.69)
    B. �� Irregular astigmatism
    - also check one or more as applies:
    �� Status post cataract surgery (367.22, V45.61)
    �� with IOL (367.22, V45.61,V43.1)
    �� Other eye or adnexa surgery (367.21, V45.69)

Similar Threads

  1. Medicare and Routine Foot Care
    By gailgordon314 in forum Podiatry
    Replies: 3
    Last Post: 09-13-2012, 10:23 AM
  2. Medicare routine physicals
    By kseifert in forum Medicare Regulations
    Replies: 2
    Last Post: 08-24-2011, 09:11 AM
  3. Medicare denial for routine eye procedure
    By missyah20 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 07-20-2010, 07:53 AM
  4. Medicare and routine exams
    By KristieStokesCPC in forum Family Practice
    Replies: 7
    Last Post: 07-15-2008, 01:45 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.