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The Florida Society of Ophthalmology

The EyeMDs

Denied Claims to NCCI Edits

First Coast Service Options, Inc. (First Coast), the Medicare Administrative Contractor for jurisdiction 9 (MAC J9) which includes Florida, Puerto Rico and the U.S. Virgin Islands, is aware of the issue related to the inappropriate claim denials for certain eye visit services (92012/92014), when the codes are billed with other services performed on the same date of service and appended with modifier 25. A July 2013 NCCI edit has the services 92012 or 92014 bundled into column one CPT/HCPCS codes that describe surgical procedures with a global period of 0, 10, or 90 days. However, the computer system is not recognizing the applicable modifiers that allows bypass of the edit.

First Coast has reached out to Centers for Medicare and Medicaid (CMS). CMS has confirmed that the MACs should expect to receive additional guidance from them in the near future on this issue. When the October release is implemented to "fix" this issue, it is expected to be retroactive back to July 1, 2013.




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