Wiki Claim Rejections for new extended eye exam codes 99201 &99202

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chelseakb

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Is anyone else getting claims rejections for the new 99201 and 99202 cpt codes since 7/1/2020? I have checked for new CCI edits and for any PTP and MUE edit changes and find no reason for these codes to reject. Any suggestions?
 
99201 and 99202 are not opthalmology codes; they are new patient E&M codes. If you billed those instead of 92201 and 92202, that might be the problem.
 
Could you better clarify what you mean by "extended eye exam"? If you're referring to extended ophthalmoscopy, 92201 and 92202, then be sure the necessary exam notes and drawings are included in the file.

Tom Cheezum, OD, CPC, COPC
 
Cheezum51 said:
Could you better clarify what you mean by "extended eye exam"? If you're referring to extended ophthalmoscopy, 92201 and 92202, then be sure the necessary exam notes and drawings are included in the file.

Tom Cheezum, OD, CPC, COPC
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You are correct. I did enter the wrong CPT in my question. I am referring to the 92201 and 92202. I am also looking for an audit tool for these two types of exams. The drawings are in the notes. Thanks for your clarification request.
 
I'm not sure you'll find an audit tool specific for those two codes. I think that if the provider follows the criteria for a standard Interpretation and Report, along with the drawings, that would suffice. However, for the 92201, since it specifies that scleral depression must be done, I'd be sure to mention that in the report.
Tom Cheezum, OD, CPC, COPC
 
What are you billing with these codes? Some services are considered bundled with this code, like injections.
 
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