EyeNet Magazine


 
Savvy Coder: Coding & Reimbursement

Coding for Dry Eye: Part 2, Beyond the Plug
By Sue Vicchrilli, COT, Academy Coding Executive,
and David B. Glasser, MD, Academy Health Policy Committee
 
 

This baseball season, Rick Robison* had planned to get season tickets for his local team. But instead of joining his buddies at the ballpark, he’s been watching his beloved Phillies on TV—because even the slightest breeze hurts his eyes.

Cauterization of the Puncta

He tried artificial tears, ointments and, most recently, punctal plugs. He had hoped that the plugs would finally allow him to visit the ballpark. They gave him temporary relief, but fell out. Mr. Robison tells his physician that he still suffers from rough, dry, irritated eyes and blurry vision. The physician’s diagnosis is exposure keratoconjunctivitis and he closes all four puncta with cautery.

What code do you use? The appropriate diagnosis code is 370.34 exposure keratoconjunctivitis. Use CPT code 9921X or 92012 for the appropriate level of exam. Modifier –25 is appended to the visit indicating a separately identifiable service is performed the same day as a minor procedure. Use CPT code 68760 closure of lacrimal punctum; by thermocauterization ligation or laser surgery. The global period for code 68760 is 10 days. There are several ways to code this:

  • Medicare recognizes the –E modifiers. The procedure could be billed as a four line item listing 68760–E1, 68760–E2, 68760–E3 and 68760–E4.
  • For Medicare and non-Medicare payers, you can bill as a two-line item: CPT code 68760–50 and CPT code 68760–51–50.

Payment would be 100 percent of the first procedure and 50 percent of the subsequent three procedures.

Suturing the Eyelids

Mr. Robison’s cornea continues to deteriorate. The physician performs temporary closure of Mr. Robison’s right eyelids by suture.

What code do you use? The correct CPT code is 67875 temporary closure of eyelids by suture (e.g., Frost suture). If the procedure is performed within the global 10-day period of cauterizing the punctum closed, it is appropriate to append modifier –58 indicating a lesser procedure is being followed by a greater procedure. The anatomical modifier –RT should also follow modifier –58.

The procedure to suture the eyelids closed, CPT code 67875, has a bilateral indicator of zero, indicating the procedure will be paid by session, not by eye if ever performed bilaterally.

Figure 1

CAPTION: Punctal plugs failed to relieve his dry eye symptoms, so the physician cauterized all four puncta—but what codes should we use to ensure that we are reimbursed?

Implanting a Gold Weight

The physician’s next step is to implant a gold weight in Mr. Robison’s upper right eyelid.

What code do you use? CPT code 67912 correction of lagophthalmos, with implantation of upper eyelid load (e.g., gold weight) is the correct CPT choice. Use anatomical modifier –RT.

_________________________________
* Patient name is fictitious.


 

Coding Clues

CPT code 67875 suture of eyelids has a zero-day global period. Therefore, if the gold weight was implanted following this procedure, the only modifier necessary would be the eye or anatomical modifier –RT or –LT.

CPT code 67912 has a 90-day global period. It received ambulatory surgical center coverage in July 2005. The ASC payment group is five with a typically allowed amount of $510 to the facility.

The ASC should bill HCPCS code L8610 for the supply of the gold weight.



 

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