EyeNet Magazine


 
Savvy Coder: Coding & Reimbursement
Common Coding Errors, Part One
By Sue Vicchrilli, COT, OCS, Academy Coding Executive
 
 

What common coding traps should you watch out for? A panel of experts tackled this question at the Academy’s Annual Meeting in New Orleans last November. John Haley, MD, OCS, Stephen Kamenetzky, MD, OCS, Donna Marks, CPC, CCS-P, OCS, and Sue Vicchrilli, COT, OCS, warn you to check how you are coding for the following situations.

Suture Removal

When is suture removal separately payable? Only in two cases: CPT code 15850 Removal of sutures under anesthesia (other than local), same surgeon; or 15851 Removal of sutures under anesthesia (other than local), other surgeon.

In all other cases, it is either part of the global surgical fee or—if you were not the surgeon or if the patient is out of the global period—part of the E&M code or Eye Code. Laser suture lysis is considered suture removal. It is inappropriate to code 66250 Revision or repair of operative wound for this service. Finally, for CPT purposes, a suture isn’t considered a corneal foreign body, so you can’t code it as foreign body removal.

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Benign and Malignant Skin Lesions

When coding from the “Surgery/Integumentary System” section of CPT for either benign or malignant lesions, keep the following points in mind.

The CPT codes. The relevant codes are:

11440 Excision benign lesion, face, eyelids; excised diameter 0.5 cm or less
11441 0.6 cm to 1.0 cm
11640 Excision malignant lesion, face, eyelids; excised diameter 0.5 cm or less
11641 0.6 cm to 1.0 cm

  • The site of service differential. Each code has a site of service differential. Payment to the physician is greater when the service is performed in the office instead of in an ASC or hospital.
  • Global periods. Each procedure has a 10-day global period.
  • ASC coverage. Each procedure became payable in an ASC beginning in January of this year.
  • Payment. Each procedure is payable per session, not per lesion, per lid or per eye. It is not appropriate to append modifier –59, indicating a separate site; modifier –50, indicating bilateral procedure; modifiers –RT and –LT, indicating bilateral procedure; or modifiers –E1 to –E4, indicating lid location.

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Complications During the Global Period

When a complication develops during the global period, it might be appropriate to use modifier –58, –78 or –79.

Modifier –58 Staged or related procedure or service by the same physician during the postop period. This modifier can apply in three circumstances:
1) When performance of this later procedure was determined preoperatively.
2) When this later procedure was more extensive than the original procedure.
3) When therapy is performed following a diagnostic surgical procedure.

Examples where you might apply –58:
1) A patient underwent 66761 iridotomy, and now needs 65855 selective laser trabeculoplasty within the 90-day global period. The surgeon indicated the possibility in the medical record.
2) During the 90-days postop period of 67105, 67107 repair of retinal detachment; scleral buckling is performed on the same eye. Use CPT code 67107–58–eye modifier.
3) The patient presents during the postop period of a trabeculectomy. A therapeutic injection of 5FU is given. Use CPT code 68200–58–eye modifier and J9190 for fluorouracil.

Modifier –78 return to the operating room (or laser suite) for a related procedure during the global period.

Example of when to apply –78: Cataract surgery with IOL implantation is performed in the right eye. During the 90-day postop period, a YAG capsulotomy is performed in the right eye. Use CPT code 66821–78–RT.

Modifier –79 Unrelated procedure or service by the same physician during the postop period.

Example of when to apply –79: Cataract surgery is performed in the left eye during the global period of cataract surgery in the right eye. Use CPT code 66984–79–LT.

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