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Costly Coding Errors

Submit claims correctly the first time to avoid costly coding errors that affect the financial health of your practice.

Coding Errors Q/A


Case Resolution
Retina OCT and glaucoma optic nerve performed on the same day Our OCT representative told us we are going to be able to start billing both the optic nerve (92133) and the retinal OCT (92134) on the same day. This is incorrect. CPT codes 92133 and 92134 have a mutually exclusive bundling edit and as such both would never be payable on the same date of service. Only the test with the lower amount would be paid.
Combined cataract and entropion repair surgery Our Medicaid only patient needs both cataract and lateral tarsal strip to repair entropion. We would like to adapt our cataract consent to include the entropion repair. We would also like to have the patient sign an Advanced Beneficiary Notice (ABN) for the entropion repair. Both these services are separately payable. ABN forms are only recognized by Medicare Part B. If a procedure is denied by Medicaid the physician will have to absorb the cost, as by law, Medicaid patients cannot be balanced billed. 

Be sure to preauthorize both surgeries.
Corneal foreign body removal Surgeon removed 3 corneal foreign bodies in the left eye. One perforated but sutures were not required. CPT code 65222 was selected. Surgeon wants to bill:

65222-LT
65222-59-LT
65222-59-22-LT
No matter how many foreign bodies are removed, payment is per eye, not per foreign body. Correct coding is 65222-LT only.
Reposition of IOL Patient underwent a repositioning of their IOL (CPT code 66930 Removal of lens material; intracapsular, for dislocated lens). We would like to append modifier -76. Two problems with this case.
1. The correct CPT code is 66986, not 66930.
2. The appropriate modifier to use is -78 to indicate unplanned return to the operating/procedure room by the same physician during post operative period.
Comanagement Surgeon bills globally for all surgical procedures performed, but often he asks the patient to return to their referring optometrist for follow-up during the global period. The optometrist is coding either E&M or Eye code visits. This is not appropriate billing. The optometrist should submit the surgical code appended by modifier -55 indicating postoperative management only with dates of service from when they first see the patient until the end of the global period.
Avastin billing in an Ambulatory Surgical Center (ASC) Our office provided the Avastin used for the intravitreal injections at ASC with another procedure. Medicare claim is unprocessable reason invalid place of service for J9035 only. The ASC should bill for the Avastin using HCPCS code C9257 with 5 in the unit field.

It is not appropriate for the physician to bill for a covered ASC drug.
Avastin and Skilled Nursing Facility SNF) In our office, a SNF patient was injected with Avastin. The claim was paid. Sometime later the payer asked for a refund of the payment for the drug. Can they do this?. Injectable medication is not a covered benefit to patients while they are being rehabilitated in a SNF. Technically the SNF is responsible for payment.