Question: An established patient was seen at our office, and we submitted eye visit code 92014. After evaluating the patient and due to severity of condition, our physician sent the patient directly to a specialist outside of our practice for further evaluation on the same day. The payor is now denying our claim (92014) stating "Benefit Max". Upon calling the payer, I was advised that another claim for same specialty was already paid for the same date of service. So basically, they received the claim from the other ophthalmologist, paid the claim and is now denying ours. Is this correct? Or should we be paid too? 

Answer: Both physicians should be paid. The issue is the frequency of the comprehensive eye visit code. Submit the appropriate level of evaluation and management (E/M) and the claim should be paid.