Wiki 67028 help

[cwilno]

Hello, We have received multiple denials for 67028-50 and when calling on the claims are being told that since 2012 the procedure can't be performed bilaterally on the same visit. We have also received a RAC audit refund request on an E/M-25 service billed with 67028, also stating since 2012 they are not to be reimbursed on the same day. I have recently seen that E/M services will no longer be allowed but can anyone tell me if they are having the same problem or where I can locate current information on 67028 billing. On my search most documents I find are outdated and I cannot locate it in MCR's manual.

 

[fhromeo30]

I code 67028 on both eyes on the same visit a lot. I use rt and lt. I never use 50 on my eye coding. I am not aware of any denials for E/M and injection on same day--I need to ask about that.

 

[RebKayTay]

?
Indicator 1 ? 150 percent payment adjustment for bilateral procedures applies

67028 has a bilateral indicator of 1. That means if done on each eye on the same day you should be reimbursed for both eyes.

We are reimbursed for this separately and because it has an indicator of 1 you are correct in billing with a -50 modifier and 1 in units per CMS guidelines. It may depend on the payer though they may require RT and LT