Wiki Medicare Denials 92014

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alumnieib

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I am doing follow up for a large Hospital Clinic and all of their eye exams are being denied CO-50 (92014). They are being billed for cataracts and other medical conditions, not routine. Does anyone know the policy?

Thank you!
 
92014 is a routine code and Medicare will not pay it. They should be billed as office visits using 992xx codes as appropriate based on new/established patient and level of care.

Tracey
 
Medicare Part B will pay on 92014 with a medical diagnosis. I work for an optometry practice and have worked for an ophthalmology practice and have billed this way successfully in both.

That being said, many secondary insurances require a 99xxx code with a medical diagnosis, and if that is the case, I will make sure to bill with a 99xxx code.

You say you work for a "hospital clinic" - are your patients inpatient or outpatient?
 
All outpatient. So what would a possible reason be for denying with a CO 50? There is no NCD or local LCD. Any thoughts? (like I said all have a medical dx)
 
Sometimes surgery has been scheduled, sometime no record of surgery or there is other medical dx such as vitreous occlusion. All are denied CO50
 
Are these all Medicare denials? They should pay for 92014. Actually, they do. Also, the code has utilization parameters. If the patient has had too many of these comprehensive visits within the same year, that may be causing denials.
I would call and find out. Maybe there's a problem somewhere else.
 
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