Medicare Denial on Billing Bilat 92225 & 92235 when Pathology Found in only 1 Eye


I have run into a situation where Medicare is billed for bilateral 92225 &
92235, with a confirmed dx of H34.8110, H35.3121 and H35.351, and denies the
charges for the left eye as there was no pathology found in it. It is good
medical practice to examine the contralateral eye, not just the eye with the
complaint, but they are saying the dx that is right eye specific conflicts
with the modifier LT!

Can anyone share with me what they have found would satisfy Medicare, as of
course they will not pay on a routine screening code either?

Much TIA,

Carol Barrett


Ph: 714 277-4478

FAX; 714 277-4010

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