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ROP exams billing and doc

  1. #1
    Default ROP exams billing and doc
    Medical Coding Books
    I am Compliance Administrator for a large multispecialty practice and feel pretty comfortable with most of the specialties. But a question has come up for me as i review our Eye group for the first time.
    We do lots of ROP (retinopathy of prematurity) exams in the hospital. I am finding that the docs are documenting the exam (92226) exactly as required with the drawing, etc. But this is their only documentation and includes the drawing and then the impression documentst he staging and when the next exam will be. My problem is that they are also billing an E/M code - generally 99233. But I see nothing in the documentation that supports the E/M code.
    Am I missing something or should they bill only the procedure (92226) code?

    Thanks in advance your guidance.

    Lee Ann Atkinson, CPC, CHA

  2. #2
    Default procedures with E/M
    Using Ingenix encoder pro I see no conflicts but the 92226 should "stand alone": what done, why done, what was result, what done about it. The E/M should also stand alone; that is, if the procedure note was removed what is left to code? Also, does the E/M of 99233 meet all the criteria of: det hist/det exam/ high mdm? As with any procedure performed with E/M service, the medical necessity of the procedure should be clearly documented. Think like an auditor; you might have to answer to one!

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