Forum - Questions & Answers

Aug 18th, 2014 - Jatin 3 

Ophthalmology Medicare denial

Hello,

I have been billing to Medicare for an ophthalmologist in Northern CA but have been receiving denials. We bill 92004 with 92015 as well as 92014 or 92014 with 92015, but we are getting denials on both of them as not covered when considered routine (for 92004, 92014, and 92012) and for Not covered with this procedure (for 92015).

Can you please help me on this ASAP.

Thanks,

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Aug 18th, 2014 - LBAROGIANIS 250 

re: Ophthalmology Medicare denial

92004 IS FOR NEW PATIENT
92014 IS FOR EST PATIENT
92015 Determine refractive state

You can't billl 92004 with 92014. You should be able to get paid for 92004 with 92015 if the patient is new. If not, then you should be able to bill 92014 with 92015. According to CCI edits from AMA. However, depending on the diagnosis could be considered routine. Also you should go onto your Medicare's contracters website and save the NCCI edits into an Excel spreadsheet. This will tell what codes can be billed or what needs a modifer.
Hope this helps.

P.S. try this website http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/ReferenceII.pdf

Sorry quoted MUE's when it should be NCCI edits. MUE is to show you how many units can be billed..

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