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Coding Is a Team Sport
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While the physician is ultimately responsible, it takes the entire ophthalmic team to stay current with coding changes, implement the updates into the practice, submit the claim and then process (or resubmit) the explanation of benefits correctly. I often joke that if we saw only one or two patients a day, we’d get it right 100 percent of the time. Obviously, we see substantially more patients with a plethora of insurance coverage — all of which may vary.

undefinedHow do you keep up? One solution is to dedicate a part of each staff meeting to coding updates or a coding quiz to make sure the team is on the same playing field.

Question Answer
Prior to inserting punctal plugs, what documentation should be noted in the medical record?
(1) Complaint indicating dry eye symptoms such as burning, excessive tearing, sensitive to light, etc.
(2) Evidence that other methods of treatment have proven unsuccessful.
(3) Documentation of tear/gland deficiency or a Schirmer tear test.
What is the correct CPT code when inserting silicone punctal plugs?
Whether collagen or silicone, the code is the same - CPT code 68761 Closure of the lacrimal punctum; by plug each.
True or False - All punctal procedures are payable per puncta.
False. Only CPT code 68761 Closure of the lacrimal punctum; by plug each, is payable per puncta. All other lacrimal procedures are payable per eye.
True or False – Glare testing, brightness acuity testing, and potential acuity measurement are separately billable.
False. These tests are included, but not countable, elements of an exam.
Besides the patient’s health/vision insurance, what other payers may be responsible for an ophthalmic exam?
Workers Compensation, home owner insurance and automobile insurance.
True or False – Category III codes such as 0192T Insertion of anterior segment aqueous drainage device, without extraocular reservoir; external approach, are for new technology. As such, they are not always assigned a global period until there is a payer specific coverage policy. True.
True or False – Medical records should be documented in black or blue ink.
False. However, since medical records need to be copied on occasion, black and blue ink make the duplication easier to read.
True or False – The management of complications following surgery are not covered unless a return to the operating room is required.
False. With the relatively new language for modifier -78 Unplanned return to operating/procedure room for related procedures by the same physician during postoperative period, procedures performed in the office setting (procedure room) are a covered benefit.

Questions you’d like to have addressed in the Coding Bulletin should be emailed to List “Questions for Coding Bulletin” in the subject line.

Editor’s note: Coding Bulletin is just one of many benefits available to members of the American Academy of Ophthalmic Executives. Learn more about AAOE membership on the AAOE website. Membership is free for residents and young ophthalmologists in their first year of practice.

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About the author: This article was adapted from an article that appeared in the February 2011 issue of Coding Bulletin. It was written by Academy Coding Executive Sue Vicchrilli, COT, OCS.

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