Hi all. How do we bill Medicare for a routine exam (92014) with a threshold visual field? We have an established patient who we already know has glaucoma, but when we billed it we only got reimbursed for the visual field with the reason being that these services are bundled. Do I need to use some modifiers, or do we still have to have the patient come back at a follow up visit every year specifically for the visual field?
1. Routine exams are not 92014. It's a comp ophthalmological.
2. MC doesn't pay for routine.
3. If the dx is glc, it's not routine, so your service level is correct.
4. VFs are not bundled with ophthalmological exams, unless you submitted a screening code.
5. Did you do a threshold 92083? They should pay.
We billed 92014 with 92083. Im thinking we must have had the wrong dx code. Thank you for the help :)
100% wrong Dx
We just got the EOB but they paid for the vf and not the exam because its a "bundled" service. We submitted with glc dx and the g-code. What am I doing wrong?
The issue is the 92014. 92014 is the code used for a Routine comprehensive exam. What we bill the VCP's for day in and day out.
This is for a medical purpose for the Evaluation and Management of a condition/disease. Therefore the E/M codes are needed. 99213 or 99214 is what is typically billed based upon the elements done and the complexity of the exam.
You may need to use modifier 25 for the fields to indicate that a significant and separately identifiable E&M service was provided on the same day as another E/M service.
Last edited by Jubilee; 03-14-2014 at 07:40 PM.
"Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland
There are currently 1 users browsing this thread. (0 members and 1 guests)
Posting Permissions
Reply With Quote
Bookmarks