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Thread: Please Help!!!

  1. #1
    Join Date
    Apr 2007
    Iowa City, IA

    Default Please Help!!!

    AAPC: Back to School
    Our Ophthalmologist is doing refraction (92015) after every cataract surgery. Is this a common practice? Refraction doesn't pay by Medicare. She feels she needs to refract the patient after the surgery to make sure it worked.

  2. #2


    Our office performs refractions at the 4 week PO visit.

  3. #3


    My doctor does the same.....on week 4 or 5. It's just part of the postop period and is not billed separately.

  4. #4


    None of my physicians refract patients post-cataract. It sounds like a personal preference but the physician needs to understand that it will be patient responsibility. There is no need for an ABN form but it is always a good idea.
    Good luck,

  5. #5


    You can refract the patient whenever you feel it is appropriate and/or necessary. You have what are called "diagnostic" refractions which is what the physician is basically doing just to see how everything is coming along.

    IF the doctor wants to do a final refraction and perhaps give a script for glasses to the patient, or the patient requests a prescription for glasses, we bill for those. These are not "diagnostic" at this point.

  6. #6


    Also, you do not give a ABN for non-covered services. If the patient wants you to file a claim to insurance (Medicare in this case as ABNs are only for Medicare patients), you add a GY modifier to the 92015. That tells Medicare that you are sending the claim at patient's request and they will automatically deny it. Sometimes patients need to see the official denial before they will pay out of pocket, and sometimes they have a secondary payer that will cover non-covered Medicare services and they need the EOB, or you want it for tax purposes.

  7. #7
    Join Date
    Apr 2007
    South Miami

    Default 92015 after Cataract surgery

    should not be billed and/or paid by patient. it's part of the global surgery package

    Code 92015 is considered typical postoperative follow-up care included in the surgical package for cataract extraction surgeries. Therefore, this service is not reimbursable when billed in conjunction with or within the 90-day post follow-up period of CPT-4 codes 66840, 66850, 66852, 66920, 66930, 66940 and 66982 – 66985.


  8. #8


    Luz, that reference you posted is for California Medicaid?
    They have a whole other set of rules but I have never, in my 35 years of doing ophthalmology, heard, seen, or read that, by payor guidelines, 92015 was part of a cataract's global surgery packet.

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