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New retina specialists

Kathy Posted Wed 29th of May, 2013 15:21:41 PM

We have hired a new retinal specialists, she is seeing our pts. with retinal issues and billing out 92014 ( a comprehensive exam )with a retinal scan (92134). She is seeing these patients as a retinal consultant. One of our MD's has already seen these pts within the last few months and also billed out a comprehensive exam (92014). Will this present a problem on reimbursement? She will be billing out under our group NPI number.

Kathy Posted Fri 31st of May, 2013 12:10:43 PM

IS ANYONE REVIEWING THIS QUESTION???

SuperCoder Answered Fri 31st of May, 2013 21:33:24 PM

Hi,

We have this query with our editor. I will respond soon.

Thanks

Kathy Posted Tue 04th of June, 2013 12:54:29 PM

I would like an answer today if possible. Thank you

SuperCoder Answered Wed 05th of June, 2013 00:37:06 AM

All services require medical necessity. The "repeat" comprehensive exam would need to be medically necessary, but given that the provider is a ophthalmology sub-specialist, that may be sufficient to support the reason for the comprehensive exam if the documentation does as well.

The following is from the CPT Assistant:
Question: The guidelines for comprehensive ophthalmological service codes 92004 and 92014 indicate that these services always include initiation of diagnostic and treatment programs. Does this mean that the provider must initiate diagnostic and treatment programs to bill and report at this level? Or does it mean that diagnostic and treatment programs are not separately reported?
Answer: CPT codes 92004, Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits, and 92014, Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits, always includes initiation of diagnostic and treatment programs, such as arranging for special ophthalmological diagnostic or treatment services, consultations, laboratory procedures, and radiological services, The provider must initiate or continue a diagnostic and treatment program in order to report one of these comprehensive ophthalmological services codes. This means that it is required and not separately reported. Initiation of diagnostic and treatment program includes the prescription of medication, and arranging for special ophthalmological diagnostic or treatment services, consultations, laboratory procedures, and radiological services.

Kathy Posted Wed 05th of June, 2013 12:00:58 PM

Thank you.

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