# Ophthalmology Coding



## cpccoder2008 (Mar 22, 2010)

Since we don't have an Ophthalmology headline i'll post it here since i am referring to Medicare. For the past several weeks i have been denials on my ophthalmoscopy. I submit both with RT & LT on each one, with most of the time seperate diagnosis as well. Lately they have been paying one and deny the other as duplicate. Anyone else having this problem ?


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## smarcolina (Mar 24, 2010)

I have not had any issues with Medicare regarding is code.  I would call Medicare and ask.  Is there a specific denial code associated with the denial?


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## cpccoder2008 (Mar 31, 2010)

Yes, duplicate,  even though it's LT & RT. They said to send a redetermination letter with medical records for review.


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## vpcats (Apr 1, 2010)

cpccoder2008 said:


> Yes, duplicate,  even though it's LT & RT. They said to send a redetermination letter with medical records for review.



You're billing 92225 (or 92226) LT and 92225 (or 92226) RT, each on a separate line?  Each with its own diagnosis?
This shouldn't be getting denied as it is a unilateral procedure payable per eye (assuming there is medical necessity for each eye).  

if you're billing a level 4 or 5 new patient E/M or level 5 follow-up E/M, they may request documentation to make sure your "ophthalmoscopy" is indeed a Indirect Extended ophthalmoscopy.

Medicare has rules for these codes.


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## cpccoder2008 (Apr 7, 2010)

Yes i'm billing with seperate dx and seperate lines. Provider relations states that it might have hit two seperate times causing it to deny for duplicate so just send a corrected claim letter and they will review it.


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