Wiki Ophthalmic 92 codes being denied by commercial payers as Routine

[CINDYB]

We have been getting denials from commercial payers stating the 92 codes are Routine only codes even if the diagnosis is medical. They are also making the patient responsible. Is anyone else having this issue? Our practice is in Virginia.

 

[Cheezum51]

I've heard this from docs in Virginia and other states. Not sure why this is happening. One coder said they were also billing the 92015, with the refractive codes for that with the 92 codes with medical codes. They stopped billing the 92015, because it wasn't going to be paid anyhow, and they were getting paid.

If you're not billing the 92015, then I think a call to the insurance company is in order to get that straight. However, remember that the 99 codes pay more this year and are easier to qualify for and document than in the past.

Tom Cheezum, OD, CPC, COPC

 

[lawl.shan@gmail.com]

Some payers have a limit of "92" eye exam codes that they accept, even if it hasn't been previously accepted. We use AAO as a resource for our ophthalmology coding, and through that resource, we were directed to use a 99 E/M code and rebill. We have had great success with this. Here is a link for another resource.

https://www.aao.org/eyenet/article/when-you-should-not-use-an-eye-visit-code