09/11/12 Ask-the-Contractor Teleconference (ACT ... - WPS Medicare

code got moved under low vision services or not at this point Does any of
the make sense http://www.wpsmedicare.com
to you
Bonnie:
Jim Williams:
Dr. Boren:
Jim Williams:
Dr. Boren:
Jim Williams:
Dr. Boren:
This is Bonnie. The 99250, the fundus photography, is payable for more than
what’s in the low vision, of course and that’s why you’re not getting any
denials.
Yes. And we haven’t gotten any from you all and we don’t have any problems
with Medicare or with WPS specifically.” We’ve had a couple of – oh, come
on, brain think – Humana and Medicare replacement policies that have
refused to pay that and said, “OK.” You know they’re saying that the fundus
photography falls under low vision services and to check back with our
Medicare carrier for that LCD. Like I said, we’ve been getting paid on it and I
just, you know, while we’re doing this, I know that changed on 8/20. I’m
looking at my newest remittance advice and I see that we’ve gotten paid for it
on, you know, date of service 8/24. So I don’t know if something is out of
whack with the Humanas of the world and the Medicare replacements. How
would you go about, you know, changing that or…
But if the problem is not with us.
Right.
That I’ve enough trouble doing my own job without trying to do the job for
Humana company, so…
Yes and that’s just it. You know, they’d say, “OK, go back to your Medicare
provider or your Medicare carrier" and we don’t have any problem
whatsoever with our Medicare. They’re still being paid through because the
diabetic code is the macular degeneration code, it’s a glaucoma code, but
they’re disallowing on all those other ones and I know that’s not WPS’
problem, but they keep pointing it back at our carrier. So I guess we’ll just
kind of go their chain of command and – but I didn’t know if you guys took
that code out of general usage and just lumped it under that, you know …
It’s very difficult to have any specific CPT code in two separate policies.
Because what happens is you cannot send out a denial then based on the
policy number because the computer sees two different policies with that
CPT code. So I’m not familiar with any contractor that has a CPT code that is
in two separate policies.
I suppose it could be – I just can’t think of any because it becomes a real
systems issue when that happens.
Jim Williams:
Yes and I guess I was just worried that that’s what this would become.
Because of this fundus photography got pulled under the 32007 ad I guess
I’m just trying to read into it and say, “OK, if that is under that LCD now and
we go down and see the ICD 9 codes that support the necessity, they’re all a
low vision code.” If we look at that particular LCD.
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