Medical Billing Forum

Coding => Coding => Topic started by: Ruthie1972 on February 23, 2016, 09:54:16 AM

Title: Codes H25.11, H25.12 and H25.9 cataract coding
Post by: Ruthie1972 on February 23, 2016, 09:54:16 AM
Hi there
Is anyone proficient in cataract surgery coding? We are the anesthesiologist and we keep tying to bill Medicare the above codes, I keep getting rejections stating due to HCPCS? Has anyone had issues with this? Thank you.
Title: Re: Codes H25.11, H25.12 and H25.9 cataract coding
Post by: Michele on February 23, 2016, 12:08:11 PM
The codes in your subject line are ICD10 codes so if the diagnosis is stating due to "HCPCS" it must be something else.  Without more info there is no way to tell.  Did you get a specific denial?
Title: Re: Codes H25.11, H25.12 and H25.9 cataract coding
Post by: Ruthie1972 on February 23, 2016, 02:16:25 PM
Hi Michele
I know, but unfortunately Medicare will not provide me with any other information? It is the oddest thing. I called the surgeon's office to try and get another DX, that is the only thing I can think to do. Thanks for answering.
Title: Re: Codes H25.11, H25.12 and H25.9 cataract coding
Post by: Michele on February 25, 2016, 07:44:01 PM
That is strange.  I guess calling the surgeon is the only other option.  If that doesn't work I would call Medicare again and hopefully a different rep will be more helpful.  Good luck!

Title: Re: Codes H25.11, H25.12 and H25.9 cataract coding
Post by: Ruthie1972 on February 26, 2016, 10:10:23 AM
So true, how that does happen. One person can always give a different answer. Have a great weekend.
Title: Re: Codes H25.11, H25.12 and H25.9 cataract coding
Post by: Jeena on May 03, 2016, 06:51:47 PM
I would try only using codes H25.11 and H25.12 and not using H25.9 because in I-10
H25.11- age related nuclear cataract right eye
H25.12- age related nuclear cataract left eye
H25.9 Unspecified age related cataract

Since you always want to code to the highest degree of specificity, using H25.11 and H25.11 is proper assuming that is the correct diagnosis in the operative report, using an unspecified code doesn't seem necessary to me and should only be used when you do not have a code already specifying what type of cataract this patient has unless you are trying to say the patient has more than one type of cataract and one is specific and one is unspecified.
Maybe that will help, I don't know if that is the issue or not.
Title: Re: Codes H25.11, H25.12 and H25.9 cataract coding
Post by: Ruthie1972 on May 18, 2016, 01:56:16 PM
Hi there
Thank you so much for that  reply. Very helpful, come to find out that they were denying due to G9363 (Pqri) code and we are only allowed to use G8427. Have a great day.