Wiki no reimbursement for consults

Create Wiki
E

eivor

Guest
Messages
7
Best answers
0
Join Date: Apr 2007
Posts: 1
eivor is on a distinguished road
Angry Non payment for consults
Please I need help....I am new to an Ophthalmology practice and stumbled across a ton of denials for consults (Medicare and Blue Cross).
The claims were billed as follows:
Example #1 99204 - no modifier
92285 - no modifier
67840 - no modifier
Example #2
99204 - no modifier
92285 - no modifier
68840 - no modifier
31231 - no modifier

I asked the billers and they stated they have never used modifiers and I have always used modifiers.

Please help!!!!!
 
You stated that you are getting denials for consult codes, but these are New Patient Codes. If your patient has been seen by your practice in the last 3 years, then that is probably what the denial is for.
 
Ophthalmology coding is allowed to use either eye exam codes or new/established E&M codes. However your 99204 code needs a 25 modifier IF documentation does support the criteria of significant and separately identifiable visit in addition to the procedures. Without the 25 modifier the 99204 will not be paid.
 
You must log in or register to reply here.
Top