Wiki Ophthalmoscopy and eye inj done same day

[mavasquez]

Good afternoon,

I am wondering if anyone can help me out here or offer some insight.

Re: 67028 (intravitreal inj) and 92225/6 (Extended Ophthalmoscopy)
92225/6 is bundled into 67028 w/ an indicator of “1”. They can only be billed together if the scope (92225/6) is done on the opposite eye of the injection (67028).

What if the scope (92225/6) was done on both eyes and both eyes have pathology, but the doctor only bills for one scope of the opposite eye of the injection. Is that okay? Can that be fraudulent billing?

I appreciate any thoughts or education on this.

 

[natashalage]

I am new to coding. How about 67028-RT and 92225/6-LT to show two different sides along with medically necessary Dx showing left and right?

 

[Robdivsa]

Per my information 92225/6 is bundled into the eye that received the injection, but as long as they opposite eye has a medically necessary dx and it was drawn it is billable and not fraudulent

 

[mavasquez]

Per my information 92225/6 is bundled into the eye that received the injection, but as long as they opposite eye has a medically necessary dx and it was drawn it is billable and not fraudulent

Thank you I have since learned this. I appreciate your reply!

 

[mavasquez]

I am new to coding. How about 67028-RT and 92225/6-LT to show two different sides along with medically necessary Dx showing left and right?

Yes you got it! Thanks and welcome to the Coding world