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Patricia Posted Wed 06th of February, 2013 23:48:19 PM

I would like to know if something has changed in 2013 that I am not aware of.... I am getting denials on these screens, and the denial reason is Medicare only procedure... Please advise.


SuperCoder Answered Thu 07th of February, 2013 22:01:51 PM

Hi there! I have not heard of these being denied as Medicare-only. Can you tell me if you're billing them with anything else (such as a well child exam) or if it's Medicaid that's denying it?

Torrey Kim, CPC, CGSC
Editor-in-Chief, Pediatric Coding Alert

Patricia Posted Fri 08th of February, 2013 03:37:08 AM


Yes please see the billing below.

99212 25 DX: 564.09 787.91 520.7
99391 V20.0
90472 X 3
92551 59
99173 59

Please let me know...

Thank you for your help.

SuperCoder Answered Fri 08th of February, 2013 18:53:34 PM

For years, some payers have statutorily denied the screening with physicals (although the reason code of "Medicare only" is still puzzling)'s possible that your payer has decided to begin denying this service effective Jan. 1. You can ask for a copy of the policy in writing that states that you can't report a vision screen with the exam, and if they don't have such a policy, you should appeal.

Patricia Posted Fri 08th of February, 2013 19:14:25 PM

Thanks so much for your help..

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