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Thread: Help with Billing After-Cataract Glasses Medical Necessity to BCBS

  1. #1
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    Help with Billing After-Cataract Glasses Medical Necessity to BCBS

    I am trying to bill after-cataract surgery eyeglasses to BCBS with a medical necessity stipulation. I've been told I need Durable Medical Equipment codes, modifiers, etc. Today we were told we should use G-codes instead of v-codes for the diagnosis (!)

    Any help would be appreciated - I am at ground-zero with this again...

    Thank you!

  2. #2
    OptiWizard OptiBoard Silver Supporter
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    The medicare rules:

    Place of service is "12"

    Diagnosis is V43.1

    BC rules here in MA are the same as MC DME rules.

    Harry

  3. #3
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    You must also differentiate between diagnosis codes and procedure codes. Most "V" codes are procedure codes (V2020 for frames, for example). However, V43.1 as mentioned by Harry is a diagnosis code, THE diagnosis code, Pseudophakia.

  4. #4
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    In Minnesota The place of service for medicare in is 12 but for Blue Cross it's 11. Also Medicare is usually primary unless it's a Medicare replacement policy. It's yet another example of I what I feel must be the insurance mantra. "IF YOU CAN'T DAZZLE THEM WITH BRILLIANCE BAFFLE THEM WITH BS". And my feeling with anything to do with government is if it makes sense they won't want to do it.

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