As a physician, your staff can and should be of tremendous assistance when it comes to the complexity of coding. However, far too often, staff members have not received a firm coding foundation or had access to ongoing education from an appropriate source. As a result, coding errors and audits occur and physicians pay back thousands of dollars due to simple errors. Because physicians are ultimately responsible for CPT and diagnosis code selection, as well as chart documentation, each physician must be a competent coder.
In January, YO Info looked at three common coding errors. Below are two additional coding scenarios.
Error #4: Double Billing
True or false? Our office has been told that when using OCT diagnostic imaging (SCODI), we can bill CPT codes 92133 SCODI, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve and 92134 SCODI, posterior segment, with interpretation and report, unilateral or bilateral; retina the same day.
Answer: This is false. Per CPT description and Correct Coding Initiative edits, the two tests have a mutually exclusive bundling edit that indicates both tests, regardless of the circumstances, cannot be paid on the same day. It has to be one or the other.
Fact or fiction? We currently perform a new dry eye procedure. Prior to the procedure, we have been told to use CPT code 65205 Removal of foreign body, external eye; conjunctival superficial for the debriding. Is this accurate?
No, this is incorrect. Code for the new dry eye procedure only.
True or false? We have been told that when performing a pterygium with an amniotic membrane transplant, the surgery should be coded as CPT codes 65420 Excision or transposition of pterygium; without graft and 65779 Placement of amniotic membrane on ocular surface; single layer sutured.
No, this is also false. No matter what the source of the graft, submit CPT code 65426 Excision or transposition of pterygium; with graft.
Error #5: E&M/Eye Code Mix-up
Question: We received an audit request for 30 records for CPT code 99214 E&M established patient level 4. The ophthalmologist did not mark the code on the superbill. Instead, he marked the Eye code 92014 Established patient, comprehensive exam. The billing person then changed all the codes from 92014 to 99214.
To qualify for E&M code 99214, documentation must include a detailed history, a detailed examination and moderate medical decision-making. The problem is that our chart documentation was not set up for E&M codes, only Eye codes.
How could the physician have caught this error?
Answer: A review of procedure productivity reports would have proven helpful. Another tip is to conduct internal chart audits of the most frequently performed levels of exams. Allowables vary by payer, but for Medicare Part B, the E&M code 99214 allowable is $13 less than Eye code 92014.
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About the author: Sue Vicchrilli, COT, OCS, is the Academy’s coding executive and the author of EyeNet’s “Savvy Coder” column and AAOE’s Coding Bulletin, Ophthalmic Coding Coach and the Ophthalmic Coding series.