EyeNet Magazine

Savvy Coder: Coding & Reimbursement
Special Testing Services, Part Two: Test Your Knowledge
By Sue Vicchrilli, COT, OCS, Academy Coding Executive

Is your practice documenting its special testing services correctly? In the last Savvy Coder, I provided 10 pointers for coding compliance, and now I’m posing 10 questions to see if you’ve gotten up to speed.

Pop Quiz

Q1. There are no frequency edits for utilization. Testing services can be billed as often as medically necessary.
   a) True.
   b) False.

Q2. Medicare has standard guidelines that physicians are obliged to follow for “written interpretation of medical findings.”
   a) True.
   b) False.

Q3. Direct supervision means that the physician:
   a) Must be in the room with the ophthalmic medical personnel who are performing the test.
   b) Must be on site during the test.
   c) Does not have to be on site during the test.

Q4. Special testing services:
   a) Can be billed with any level of E&M or Eye Code.
   b) Can only be billed with Eye Codes.
   c) Are always bundled into both E&M and Eye Codes and must be billed alone.

Q5. Procedures that are inherently bilateral should be billed as follows:
   a) Code with the –RT and –LT modifiers.
   b) Code with modifier –50.
   c) CPT code for the test only. No modifier is necessary.

Q6. The Schirmer tear test should be billed with CPT code 95060 Ophthalmic mucous membrane tests.
   a) True.
   b) False.

Q7. In order for ophthalmic medical personnel to bill the technician code (CPT Code 99211):
   a) A physician must be on site during the service.
   b) A written order must be placed in the patient’s chart. This order would need to document in detail the exam elements and any tests that are to be performed.
   c) Both a and b.

Q8. Medicare will pay ophthalmologists for the professional component only of any services provided to a patient who currently resides in a skilled nursing facility.
   a) True.
   b) False.

Q9. Special testing services are not payable during the global surgical period because they are included as part of the surgical package.
   a) True.
   b) False.

Q10. Gonioscopy is:
   a) Payable per eye when medically indicated.
   b) Payable only with the diagnosis of glaucoma.
   c) Payable when medically indicated for more than 140 diagnosis codes.

More online. What are the three levels of supervision? Which codes for testing services are payers most likely to audit? For tips and pointers, see the last Savvy Coder at www.eyenetmagazine.org/archives.


Answers to this month’s Savvy Coder pop quiz: Q1—b) False; Q2—b) False; Q3—b) Must be on site during the test; Q4—a) Can be billed with any level of E&M or Eye Code; Q5—c) CPT code for the test only. No modifier necessary; Q6—b) False; Q7—c) Both a and b; Q8—a) True; Q9—b) False; Q10—c) Payable when medically indicated for more than 140 diagnosis codes.


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