AAO announces that CMS will Accept Resubmitted Claims for CPTs 67228 and 65855

In a post on June 9 to members, the American Academy of Ophthalmology (AAO) announced that ophthalmologists who received incorrect denials for CPT codes 67228 (treatment of extensive or progressive retinopathy …, photocoagulation) related to the global period or for 65855 (trabeculoplasty by laser surgery) related to the bilateral indicator could re-submit these denied claims after July 1, 2016.

The AAO post noted the following: “The Academy pointed out to CMS that the agency had not changed the global period from a 90- to a 10-day service for CPT 67228 (laser panretinal photocoagulation). Additionally, CMS mistakenly changed CPT 65855 (trabeculoplasty by laser surgery, one or more sessions) from a unilateral service to bilateral. Because of this, CMS was denying services in both eyes.” As of this writing, there is no official CMS or Medicare Administrative Contractor (MAC) publication confirming a July 1 date; it may be forthcoming soon. Monitor your MAC websites for confirmation.

Corcoran Consulting Group is aware that claims being filed for both of these laser codes are still denying as above, so it may be wise to hold those claims until after July 1, 2016.

As always, if you need assistance, Corcoran Consulting Group can help with coding, documentation, and reimbursement questions or to provide training or chart review and compliance questions. Visit our website or call us to learn more. You can link to our new App, Corcoran 24/7 via one of the links below.

www.corcoranccg.com (800) 399-6565