Coding Questions from Young Ophthalmologists

When billing for post-op care after cataract surgery, should the date of service start with the same date as the surgery or should the post-op date of service start the day after the surgery?

The person assuming postoperative care should begin billing 66984-55 when he/she first sees the patient to the end of the 90-day post-op.

Can visual field and other glaucoma w/u be billed within the 90-day post-op for laser iridotomy for acute angle closure glaucoma?

All ophthalmic testing (92015-92499) is billable during the global period, as long as there is medical necessity/pathology. These procedures are not subject to global periods and they do not need modifiers other then RT, LT or 50 if applicable.

What is the average reimbursement (relative value unit) for: fluorescein angiogram (fa), optical coherence topography (oct), focal retinal laser (focal), and pan retinal photocoagulation (prp)?

• Fluorescein angiogram (92235) = 3.33
• Optical coherence topography (92135) = 1.16
• Focal retinal laser (67210 ) = 16. 03
• Pan retinal photocoagulation (67228) = 25.50

How do Medicare reimbursement rates vary by state? I was particularly interested in NJ/NY vs. VA/DC/MD area for ophthalmology. (i.e., what is RVU worth in each state?)

RVUs vary by state. CMS adopted a new methodology for determining rates. Even with the 5 percent increase, some codes values went down. Code 66984 is a good example of this. The fee schedule for every carrier is posted on each carrier’s Web site.

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Coding Questions from the Annual Meeting
Following the morning session of the YO Program at the 2007 Annual Meeting, several people had some very specific coding questions. Here are the more common questions and their answers, as provided by Sue Vicchrilli, COT, OCS, the coding executive for the American Academy of Ophthalmic Executives.