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Thread: Medical Billing Question

  1. #1
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    Medical Billing Question

    Are you able to bill an E/M 99xxx code with a 92xxx with same date of service? for instance, assume a patient had scheduled a routine eye exam, but foreign body discovered that day, billed medically and rescheduled for following week. The following week an E/M done and the patient healthy enough to go through with refractive exam. How do you bill for this? Can you bill medically and also under routine vision? Could you bill 99213 and 92015? Or even 99213 and 92004?

    Thanks!

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    My Brain Hurts OptiBoard Bronze Supporter jpways's Avatar
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    The first visit you're just going to bill a medical, for a foreign body removal, we bill it using the office visit (for example 99213 - intermediate exam existing patient) with a foreign body removal 65205/65210 (external eye codes) or 65220/65222 (corneal codes) depending on the area of the foreign body - the medical exam

    When they come back next week it's a whole new exam this time with an office visit (for example 99214 - comprehensive exam existing patient) with a 92015 (refraction) - the routine vision exam

    You do not bill both exams for the same date of service, because it's impossible to actually do, which means you're likely to get audited

    Since these are two separate exams you bill it as two separate exams.

    I hope this helps

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    jpways- thanks for the response! One more clarification- so for instance on the second visit, you can't bill a 99xxx as well as 92014 for routine vision, even though patient had chair to discuss the previous condition and then receive a comp/refractive exam? Thanks again!

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    My Brain Hurts OptiBoard Bronze Supporter jpways's Avatar
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    You're either going to bill a 99XXX or 92XXX not both, depending on the situation. Both codes are for office visits, the difference between them is the type of service offered. The 99 codes are a straight office visit, the 92 codes are for opthalmologic exams.

    Now this next part is before my time as an optician (and insurance biller), but every time I mention 92 codes I hear this story, so I know it very well:
    In our office we tend to use only the 99 codes because several years ago when the AOA and the journals first started saying that since optometrists generally preform the same exams as ophthalmologists, optometrists should start using the 92 codes. Medicare, at the time, did not agree with this argument and neither did the audit boards. So in order to not take the risk our office did not make the changeover and once we started hearing about the audit we where glad we did. Granted this is just for medical exams, since we're talking Medicare, but I still get this story regardless of the situation.

    That being said there are some insurance companies that will only pay for a 92 code for a routine vision exam (Medical Mutual of Ohio and Tricare are two that come to mind), while others, like VSP only want 99 codes. Of course there's still S0620/S0621, which by definition are routine exams, but I haven't used either of those codes since Highmark bought Davis Vision.
    Last edited by jpways; 10-09-2009 at 01:17 PM.

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    jpways is correct. You have to split the exams and the billing with most insurance companies (exceptions exist) to get paid. This is not law but a tradition and it may be contracted in some cases.

    Which one you bill depends on why the patient came to see you, their "reason for the visit". If they came in for a routine exam without symptoms and a medical issue was noticed, bill the routine exam first and sched a 2nd appointment for the medical issue.

    If the patient wrote "can't see well anymore" and the primary reason for loss of acuity was medical, bill and treat medically first then schedule a routine exam and refraction for a second visit.

    If the Dr. finds a medical issue that effects vision in a routine exam then to get max compensation he should inform the patient immediately that the exam has changed, and the routine exam will have to happen at another tiem. This way the won't get PO'd when the get an EOB from their medical insurance.

    I always explained to a patient who was confused about coming back that its in their best interest to ensure that they don't have to pay anymore out of pocket.

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    sharpstick and jpways are both correct. I'm a medical biller myself so I tend to have some experience about that.

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    A coder should have a general knowledge of common medical terminology and gross anatomy, as well as an extensive knowledge of each coding book, (CPT, ICD-9-CM, HCPCS).The new code is only for Medicare. For commercial insurance carriers you will still need to use codes 90654-90658 as appropriate which are based both on age and whether the vaccine may or may not contain preservatives. Medical coding courses should be taught by a coder who is certified through the AAPC or AHIMA.

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    You will not get total agreement on this...

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    Commenting on the person that said VSP expects 99 codes -- I've never had a problem billing VSP with a 92004/92014 with 92015 for a routine vision. In fact, I don't think I've ever billed VSP with a 99 code.

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    OptiBoard Professional shannon's Avatar
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    Quote Originally Posted by tdj View Post
    Commenting on the person that said VSP expects 99 codes -- I've never had a problem billing VSP with a 92004/92014 with 92015 for a routine vision. In fact, I don't think I've ever billed VSP with a 99 code.
    Same here!


    A man went to an eye specialist to get his eyes tested and asked, "Doctor, will I be able to read after wearing glasses?"
    "Yes, of course," said the doctor, "why not!"
    "Oh! How nice it would be," said the patient with joy, "I have been illiterate for so long."


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