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Optometrist

  1. #1
    Location
    Greensboro, NC
    Posts
    67
    Default Optometrist
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    I am working with a optometrist who has been seeing patients for eye exams at a nursing home. He had hired a consultatnt who told him to use CPT 99325 as the code. This optometrist is a medicare provider and has used the 99325 code and they are all denied. The EOB states, this is not a rendering provider for this service. I think that he should use the 92000 codes and the diagnosis should reflect the reason for the exam. If anyone has any experience with this, please let me know your ideas.
    Thanks
    C. Robinson

  2. #2
    Default
    Is the NH or part of it a SNF? If so, they get paid by their patients' part A and Medicare bundles alot of services. My OD doesn't see his pt's at NH's, but I believe the 92XXX codes, E/M codes, and certain procedures/prof components are excluded from the bundling. I think the OD can also enter into a contract with the SNF and bill them directly for the technical components of services that are applicable. There's a complete list on the cms website. Good luck!

  3. #3
    Location
    Greensboro, NC
    Posts
    67
    Default
    The 99325 is an E&M code that is being denied by Part B
    C. Robinson

  4. #4
    Default
    Sounds like you have the right codes. If you already haven't, I'd double check w/the facility to verify if they are even classified as a SNF, then call your Medicare carrier. I think they may need the SNF npi on the claim or something more specific. I know each carrier can sometimes have their own guidelines for the way they like to see claims come over. I hope that helps!

  5. #5
    Location
    Greensboro, NC
    Posts
    67
    Default
    Thanks for your help
    C Robinson

  6. Default any luck?
    Hi Cynthia...I recently started doing billing for an Optometrist. I found this thread, and was wondering if you had any luck? If so, could you let me know what codes seem to be correct? We have been using 99300 codes, but if there is a more appropriate code, I'd like to correct it.
    Thanks!
    Beth

Similar Threads

  1. S Code vs 92XXX code for Optometrist?
    By akwilliams2 in forum Ophthalmology/Optometry
    Replies: 4
    Last Post: 01-20-2016, 11:56 AM

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