Aetna Life Care Case Summary
Steven Lauder, SIU Investigator for Aetna Life Insurance submitted a complaint to Missouri Department of Insurance alleging a review of billing invoices over a 12 month period, revealed codes 92225 and 92226 were submitted a total of 341 times for 57 patients and that many patients were noted to have had billing code 9226 submitted 10 to 12 times in a 12 month period.
Mr. Lauder’s original complaint also noted a retinal drawing must be maintained in the patient’s record, and the drawings should include sufficient detail, standard color and appropriate labels. CPT mandates an interpretation and report which includes, at a minimum, the physician’s findings and impression. The original complaint did not specifically say Dr. Davitt was not submitting the required documentation.
Dr. Bradley Davitt was not surprised to learn he has a statistically high number of billings under the 92225 and 92226 designations as he one of the few doctors in the region qualified to do so. He is the Director of Paediatric Ophthalmology for Cardinal Glennon Children’s Hospital, specializing in the screening and examination of premature infants for “Retinopathy of Prematurity (RP)” and provides the same services for St. Mary’s Hospital in Jefferson City, Southeast Missouri Hospital in Cape …show more content…
Lauder of Dr. Davitt’s affiliation with Cardinal Glennon Hospital as Director of Pediatric Ophthalmology, and his additional coverage for St. Mary’s Hospital in Jefferson City, Southeast Missouri Hospital in Cape Girardeau, and Mercy Hospital in Creve Coeur, Missouri. Mr. Lauder said based on Dr. Davitt’s position with Cardinal Glennon Hospital and the number of other Missouri hospitals he provides services to, the high number of patients seen made sense, so there appeared to be no issues for this provider. Mr. Lauder did want to note that their current policy says any statistical anomalies should be referred to individual states Departments of Insurance for review and
Mr. Lauder’s original complaint also noted a retinal drawing must be maintained in the patient’s record, and the drawings should include sufficient detail, standard color and appropriate labels. CPT mandates an interpretation and report which includes, at a minimum, the physician’s findings and impression. The original complaint did not specifically say Dr. Davitt was not submitting the required documentation.
Dr. Bradley Davitt was not surprised to learn he has a statistically high number of billings under the 92225 and 92226 designations as he one of the few doctors in the region qualified to do so. He is the Director of Paediatric Ophthalmology for Cardinal Glennon Children’s Hospital, specializing in the screening and examination of premature infants for “Retinopathy of Prematurity (RP)” and provides the same services for St. Mary’s Hospital in Jefferson City, Southeast Missouri Hospital in Cape …show more content…
Lauder of Dr. Davitt’s affiliation with Cardinal Glennon Hospital as Director of Pediatric Ophthalmology, and his additional coverage for St. Mary’s Hospital in Jefferson City, Southeast Missouri Hospital in Cape Girardeau, and Mercy Hospital in Creve Coeur, Missouri. Mr. Lauder said based on Dr. Davitt’s position with Cardinal Glennon Hospital and the number of other Missouri hospitals he provides services to, the high number of patients seen made sense, so there appeared to be no issues for this provider. Mr. Lauder did want to note that their current policy says any statistical anomalies should be referred to individual states Departments of Insurance for review and