August's coding questions highlight topics ranging from non-par Medicaid billing, how to code for uveitis, glaucoma, hyphema (UGH) syndrome and billing ICG or OCT same day as fundus photography.

1. Bilateral Chalazion Removal 
   Our surgeon removed chalazia under anesthesia on the right and left upper lids. Should we submit two line items with –RT and –LT or one line with modifier -50?
2. Separate Code for Pilocarpine Test
   Is there a CPT code for pilocarpine testing? My physician performed this test for a dilated pupil on a patient.
3. Tube Revison Procedure Bundling
   Our surgeon performed the following procedures on a patient (CPT codes):
   • 66185 Tube revision
   • 67120 Removal of tube
   • 67255 Graft at removal site
   • 66180 Insertion of new tube in different area
   
   As there are bundling edits, are we able to unbundle and submit each procedure?
4. HCPCS Code for Avastin
   What HCPCS code do I submit for Avastin?
5. Non-Par Medicaid Billing
   While I am participating with Medicare Part B, I am non-par with Medicaid. If I see a patient with Medicare primary insurance and Medicaid as a secondary, can I balance bill the patient for the 20 percent that Medicare doesn't cover?
6. ICD-10 Codes Without Ocular Complications
   There is no code for diabetes type 1 or type 2 that includes "without ocular complications" (i.e., no diabetic retinopathy). The only available codes are E10.9 or E11.9, which do not seem correct. What diagnosis code should we submit when the patient has no ocular complications?
7. ICD-10 Codes for Removal of Silicone Oil
   We received denials for CPT code 67036 Pars plana vitrectomy (PPV) when billing ICD-10 code T85.398A Complications from silicone oil. Should we use another diagnosis as primary?
8. ICD-10 for UGH Syndrome
   How do we code for uveitis, glaucoma, hyphema (UGH) syndrome?
9. Billing ICG or OCT Same Day as Fundus Photography
   When is it appropriate to unbundle CPT code 92250 Fundus photography from either an OCT or ICG?
10. Payment Reduction When Using Modifier -50
    I performed CPT code 67908 Mullerectomy bilaterally during the same operative session. I appended modifier -50. However, the payment was less than I expected. Is there another modifier I should use?