Author Topic: Insurance never pays on 92070 - is there a better code?  (Read 1339 times)

Alice Scott

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Insurance never pays on 92070 - is there a better code?
« on: March 15, 2008, 06:17:08 AM »
Question
HI ALICE, I WORK FOR A OPTOMETRIST IN NEW HAMPSHIRE,  WE HAVE A PATIENT WITH A CORNEAL ABRASION, WE NEED TO BANDAGE EYE, WE HAVE A CODE IN SYSTEM  92070, WHICH WE HAVE IN AS BANDAGE CONTACT-MEDICALLY NESS,  INSURANCE NEVER PAYS ON THIS CODE, I CHANGED THE CODE TO READ BANDAGE LENS-MEDICALLY NESS, I WILL TRY TO SEND IT WITH THAT DESCRIPTION, AM I USING THE CORRECT CODE? IS THERE A BETTER CODE TO USE ? I WOULD APPRECIATE YOUR HELP,
THANK YOU,  LINDA

Answer
Hi Linda,

    The 92070 seems to be the only appropriate code for the service you are performing.  Many insurance plans do not allow this code so the only thing I can recommend is that you attach the patientís notes to the claim with a brief explanation that the eye was bandaged due to corneal abrasion and it was medically necessary.  There is no guarantee that they will pay, even with the explanation and notes.

Good luck

Alice
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jns85008

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Re: Insurance never pays on 92070 - is there a better code?
« Reply #1 on: July 08, 2008, 03:56:31 AM »
You could also appeal this with a Medical Necessity letter. Here's an example.

[Date]

[Inside address]


Attention: Director of Claims   
          Re: Medical Necessity

Dear Director of Claims:

It is our understanding that this claim was denied pursuant to your decision that the care was not medically necessary for [insert information here].  The explanation of benefits did not provide adequate information to establish the accuracy of this decision.  Please provide the following information to support the denial of benefits for this treatment.

Please provide an outline of the specific records reviewed and a description of any records that would be necessary in order to approve the treatment.  We will then forward any pertinent information to your company.

We would also appreciate copies of any expert medical opinions, which have been secured by your company in regards to treatment of this nature and its efficiency.  This will allow the treating physician to respond to its applicability regarding this patientís condition.      

Thank you for your assistance.

Sincerely,




[Name]
[title]