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Coding Q&A

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Following the morning session of the YO Program at the Annual Meeting in New Orleans, 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.

  1. Can you bill for emergency room consult and ruptured globe surgery on the same day?

    Yes. Select the appropriate emergency room exam code (99281–99285). Since ruptured globe surgery has a 90-day global period, modifier 57 is appropriate to append to the exam code — for example 99281-57, with 65285-eye modifier.

  2. What is the difference between modifiers 24 and 79? What is the overall frequency of modifier 24?

    Modifier 24:

    • Unrelated E&M during the global period of a surgery
    • Qualifies for eye codes.
    • Always appended to the appropriate level of exam.
    • The global period could be either a 10- or 90-day period.
    • I heard a Medicare representative state that the frequency of modifier 24 exceeds the payer’s expectation by 80 percent.
    • Many payers initially deny any claim with modifier 24 appended, but most are paid upon appeal. The key is to make sure the payer recognizes that the exam is unrelated to the surgery. The diagnosis is typically different. The problem may be in the other eye.

    Modifier 79:

    • Unrelated procedure during post-op period.
    • Appended to the surgical code, not an exam code.
    • Begins a new postoperative period in the surgical eye.
    • Typical example: cataract extraction with IOL in the right eye was performed Jan. 2 with CPT code 66984-RT. Cataract extraction with IOL is performed on the left eye three weeks later with CPT code 66984-79-LT. It’s unrelated because the surgery is in the other eye.

  3. Does gonioscopy have to have a drawing? What about just a written description?

    A written description for CPT code 92020 will qualify.

  4. Can pachymetry be billed more than once in corneal disease?

    Yes. CPT code 76514 is covered on a one-time basis for glaucoma, but is payable as medically indicated for the progression of corneal disease.

  5. Can modifier 24 be used for CME post CE/DOC?

    First, ask yourself if the patient would have had this condition if they hadn’t had the surgery. If the problem is related to the surgery, no bill should be submitted by the surgeon. If the problem is unrelated, it is appropriate to bill by appending modifier -24 to the appropriate level of exam.

  6. What is the global surgical period for pediatric surgeries? Strabismus or congenital cataract surgery?

    All these procedures have a 90-day global period.

  7. How far back can an audit go?

    There is no time limitation by any payer.

  8. Will reimbursement be the same for lateral tarsorrhaphy takedown and cataract extraction on same visit versus separate visits?

    I think the question should be, are both procedures payable in the same operative setting. The two CPT codes involved are 67710 (severing of tarsorrhaphy) and 66984 (cataract extraction with IOL). The two codes are not bundled in the Correct Coding Initiative—66984 has 17.19 RVUs and 67710 has 2.17 RVUS.

    The correct coding is 66984-eye modifier (payment will be at 100 percent of the allowable) and 67710-51-eye modifier (payment will be at 50 percent of the allowable). Many payers no longer require modifier 51, indicating multiple procedures performed in the same operative setting.

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About the author: Sue Vicchrilli, COT, OCS, is the coding executive for the American Academy of Ophthalmic Executives.