The Medicare prepayment screen that would suspend a claim for the excision of a gallbladder performed by an optometrist would be referred to as a:
- Procedure to specialty code edit
This type of edit would catch the error in the claim where the procedure (excision of a gallbladder) is not typically performed by the specialist type indicated (optometrist). Medicare prepayment screens help ensure that claims meet the necessary criteria and are appropriately coded before payment is made. In this case, the edit would flag the mismatch between the procedure and the specialty code, indicating that an optometrist is not qualified to perform such a surgical procedure.
