Tips for Frequently Coded Services: From A-Scans to YAGs, Part Three

This article is from June 2009 and may contain outdated material.

This month, Savvy Coder continues its A to (almost) Z of the most commonly performed exams, tests and special procedures.

Fundus photography. Use CPT code 92250, Fundus photography with interpretation and report. This code is inherently bilateral, which means payment is the same whether the service is performed on one eye or two. The CCI bundles 92250 with 92135, Scanning computerized ophthalmic diagnostic imaging, posterior segment (e.g., scanning laser) with interpretation and report, unilateral.

Keratoplasty. Since Jan. 1, there are five CPT codes for corneal transplants:

65710 Keratoplasty (corneal transplant); anterior lamellar,

65730 Keratoplasty; penetrating (except in aphakia or pseudophakia), used when the eye still has a natural lens,

65750 Keratoplasty; penetrating (in aphakia), used when the eye is without a lens,

65755 Keratoplasty; penetrating (in pseudophakia), used when the eye has an IOL, and

65756 Keratoplasty; endothelial, which has an add-on code, + 65757 backbench preparation of corneal endothelial allograft prior to transplantation. Add-on codes are for work that is always done in conjunction with a primary procedure. In other words, you can’t bill for CPT code 65757 unless you also bill for 65756. CPT uses the “+” symbol to flag add-on codes.

Although they are new this year, CPT codes 65756 and 65757 have already received ASC approval.

Lacrimal punctal plugs. There is something unusual about CPT code 68761 Closure of the lacrimal punctum; by plug, each—it is the only lacrimal procedure for which payment is per punctum, not per eye. The code is the same whether you are using temporary (collagen) or permanent (silicone) plugs. Typically, it is not necessary to indicate to the payer which of those plugs you used. In 2002, Medicare bundled the supply of the plug(s) with the insertion. However, non-Medicare payers may pay separately for the supply of the plug with: HCPCS code A4262 for collagen, HCPCS code A4263 for silicone, or CPT code 99070 Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided). Documentation for the patient complaint should include such terms as dryness, burning, excessive tears and photophobia. You also should document that other methods of treatment—e.g., artificial tears, ointments and humidifier—were tried before plug insertion but hadn’t worked.