Wiki New CCI Edits - Ophthalmology

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laker

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The new CCI edits effective July 1st, now bundle 67028 (intravitreal injections) with 92012 and 92014. In the past, we have been able to bill the eye visits with the injections. Why the change and where can I get more information. Thanks in advance for any help!
LA, CPC
 
RE New CCI Edits

I just read a "News Flash" from Corcoran stating that we bill as usual appending modifier 25 when appropriate for office visits w/intravitreal injections. They caution to be extra vigilant that the documentation supports the billing of the exam in addition to the injection procedure. The same was pretty much stated by others from AAOE. I guess we wait and see how well it works out!
 
Need info also

Our office had always used modifier 25 on any office visits done with an injection 67028 and starting 7/1/13 FCSO starting denying them as inclusive. Also denying the injected eye for any ophthalmscopy done. Does anyone know if 92226 is now bilateral starting 7/1/13? Our online coder is telling us it is. :confused:
 
ours are all being denied as well. We have to appeal each and every one of them. I am unsure about the ophthalmoscopies though. The Ophthalmic Coding Coach still shows billable RT and LT. Are you doing Fundus photos on the same day as well? We have had that problem before. Our insurance co's in PA don't like them together.
 
laker said:
The new CCI edits effective July 1st, now bundle 67028 (intravitreal injections) with 92012 and 92014. In the past, we have been able to bill the eye visits with the injections. Why the change and where can I get more information. Thanks in advance for any help!
LA, CPC
Click to expand...
Regarding the bundling of the office visits and the 67028. The new NCCI edits allow the unbundling with the 25 mod. However, Medicare is denying as of July 1, 2013. Medicare say's they are looking for a 59 modifer also, which does not apply correctly. We have contacted Medicare, ASRS, AAO and informed them of this problem. As of today, Medicare has informed our office that we should be billing with both a 59 and a 25 modifier(s) to ensure that the office visit does not deny. They understand that it makes no sense to any of us to go from NEVER using a 59 mod to having to use it several times a day. We have been told to watch the alerts on our pages for a written directive on the fix.
We go through Palmetto J-11 Part B - Just an FYI - The informationt that I am supplying is after 4 different calls over several days asking about 3 separate patients, speaking to 4 separate reps, 2 of which went to the Claims Research Dept and were all given this answer.
If a rep tells you to use the NCCI Tool on the website, inform them that you have already done so and it tells you to use a 25 modifier.
 
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Bundled 67028/92226

Does the 67028 also need the 59 modifer when billing with an office visit to medicare?:( And also is 92226 considered bundled with 67028 when done on the same day?
 
Ncci edit correction

Medicare is correcting all of those! You should not be using that 59 modifier unless you want to get audited. A 25 should suffice. Medicare will reprocess all claims that were denied beginning 7/01/2013 by November 16th.
 
Medicare correcting edits??

Does anyone have access to this in writing, that Medicare will be correcting these Edits?, either on the internet, email from Medicare/Medicaid, etc. Thank you, Mary
 
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