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    Coding Top 10: Cataract Surgery Without IOL Implantation, How to Use Modifier -JW


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    Coding Top 10, June 2016

    Ask the Academy Coding Experts is an online resource for trusted responses to your coding questions.

    The Academy Coding Experts receive daily questions at coding@aao.org and icd10@aao.org. We are committed to providing accurate responses so that practices are confident in their billing and coding practices.

    June's coding questions highlight topics ranging from cataract surgery without IOL implantation, denial of gonioscopy same day as other services and using modifier -JW correctly.

    1. Bilateral Extended Ophthalmoscopy Allowable
      When submitting 92226 –RT Subsequent ophthalmoscopy and 92226 –LT, the commercial payer is changing it to 92226- 50 and reducing payment to 100 percent instead of 200 percent. Should we appeal?
    2. Billing Exam Same Day as OCT and Injection
      When billing for an established patient exam along with OCT and injection, are all three payable?
    3. Treatment of Ocular Hypertension Same Day as Injection
      If a patient is scheduled for an Avastin injection and the physician also treats ocular hypertension, is the exam billable?
    4. Usage of Modifier -58
      How do I determine if a procedure requires modifier -58 pertaining to lesser to greater?
    5. How to Know When You Can Unbundle
      What is the path to unbundling? How is it determined?
    6. Performing Two Procedures Same Day
      What modifiers are required when performing both CPT code 67210 Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; photocoagulation and CPT code 67028 Intravitreal injection in the same eye?
    7. Modifier -53 and Testing Services
      When performing CPT code 92235 Fluorescein angiography or CPT code 92240 ICG and a vein is unobtainable, can we append a modifier for the supplies that were used?
    8. Using Modifier –JW Correctly
      How do you document waste for a single-use vial? How is modifier -JW used properly?
    9. Denial of Gonioscopy Same Day as Other Services
      We received a denial from a commercial payer on CPT code 92020 Gonioscopy. It was submitted along with CPT code 92012 -25 and CPT code 66761 LPI. Were they correct in their denial or should we appeal?
    10. Cataract Surgery Without IOL Implantation
      The physician discontinued cataract surgery after a pressure spike and the lens was removed, but did not implant an IOL. Three weeks later the IOL was inserted. What is the correct way to code the two procedures?