From Bundled Codes to Foiled Surgeries: Test Your Coding Competency, Part 2

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Earlier this year, Savvy Coder chal­lenged you to tackle 9 questions (see “Test Your Coding Compe­tency,” May).

In Part 2, you get another chance to demonstrate your coding savvy.

9 More Questions to Tackle

Q10. The CPT codes for glaucoma OCT (92133) and retina OCT (92134) are bundled together under the Na­tional Correct Coding Initiative (NCCI, usually shortened to CCI). Typically, 2 bundled codes—also known as a CCI edit—can’t both be billed when the 2 services were performed by the same physician on the same eye on the same day. But under certain circumstances, some CCI edits can be unbundled, which means that the 2 codes in the CCI edit can both be billed. Is it appropriate to unbundle CPT codes 92133 and 92134 as long as you have 2 separate diagnosis codes?

A. No. They are bundled together with a CCI mutually exclusive edit, which means they can never be unbun­dled.

Q11. The retina specialist refers a patient to the glaucoma specialist in the same office. When the patient sees the glaucoma specialist, should it be billed as a service involving a “new” or an “established” patient?

A. The latter. Whether you are selecting from the Evaluation and Management (E&M) codes or the Eye visit codes—and whether or not you’re using the new taxonomy designation—you must select an established patient code.

Q12. A hospital inpatient requires an ophthalmologic evaluation. The patient is transported to your office for the exam. Which of the follow­ing statements is true: a) place of service is office, b) place of service is hospital, or c) the patient himself is responsible for payment of this noncovered exam.

A. Place of service is hospital. When patients are in your records as inpa­tients, they can’t have an outpatient exam until they are released from the hospital.

Q13. Payers think it is acceptable to document an exam by copying and pasting from, or pulling forward from, a previous exam—true or false?

A. Absolutely false! While you may think this is a time-saving benefit of your electronic health record (EHR) system, it is the payer’s No. 1 area of review. From the payer perspective, payment is made from the information obtained today and pertinent to today’s exam. For this reason, some audits request a series of exams rather than a single exam note.

Q14. How often must we have the patient fill out new paperwork for the Review of Systems (ROS) and Past, Family, and Social History (PFSH)?

A. Prior documentation can be ref­erenced at each exam (if medically nec­essary and pertinent to today’s visit), but new paperwork is only needed if/when the rules change or if the patient is “new” again.

Q15. Sometimes a physician is forced to terminate a surgical proce­dures. Such procedures have a global period—true or false?

A. False. Surgical procedures ap­pended with modifier –53, indicating that the procedure was discontinued, do not have a global period.

Q16. What component of the bill isn’t paid by Medicare Part B while the patient is in a skilled nursing facility?

A. Medicare Part B will not pay for the technical component of any test, any drug injected, or postoperative cataract glasses.

Q17. Regarding CPT code 92226 (extended ophthalmoscopy, subse­quent), payment is made whether there is a change or not, as long as a picture is drawn—true or false?

A. False. Payment is for drawing and labeling the change in pathology from the past visit.

Q18. Before hiring a new physician, it’s best to check the Medicare exclu­sion list maintained by the Office of Inspector (OIG)—true or false?

A. True. If action has been taken against a physician, no payments can be made to that physician by Medicare.