Medical Billing Forum
Billing => Billing => : karric82 October 12, 2016, 06:07:29 PM
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I am new to this so please excuse any errors I might do. I am having issues with getting Medicare to pay for 67820. I billed out separately for a E1 and E3. Denial was CO-151 Payment adjusted because this payer deems the information submitted does not support this many/ frequency of services. When it was billed out it was billed out separately. Line one was 67820 with modifier of E1 and line two was 67820 modifier of E3. Thanks for your help.
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What diagnosis code did you use? Most likely it is saying that it doesn't support the service. I was not able to find an LCD regarding it but I did find a coding website with information that may be helpful: http://palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~JM%20Part%20B~Browse%20by%20Specialty~Optometry%20Ophthalmology~7R5KUQ4420?open&navmenu=Browse%5Eby%5ESpecialty%7C%7C%7C%7C
There was also a previous post about this CPT code. The information there may help you. Click on http://www.medicalbillinglive.com/members/index.php?topic=8114.0
I hope this helps.
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Diagnosis code H02.054 and H02.051 are what was used.
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The dx codes appear to be ok. I found the following which indicates that for Medicare the 67820 should be billed per eye, meaning use the 50 modifier if done bilaterally:
http://www.aao.org/practice-management/news-detail/billing-bilateral-epilation
Hope that article is helpful!