• Coding Top 10: Viscoelastic for Complex Cataract Surgery, Billing for CyPass Stent


    Coding Top 10, September/October 2017

    Ask the Academy Coding Experts is an online resource for trusted responses to your coding questions.

    The Academy Coding Experts receive daily questions at coding@aao.org and icd10@aao.org. We are committed to providing accurate responses so that practices are confident in their billing and coding practices.

    The September/October coding top 10 selections include billing for an ICL and CyPass stent as well as the use of viscoelastic for complex cataract surgery.

    1. Denial of Patch Graft 
      We billed Medicare Part B CPT code 66180 Ahmed valve and 67255 Scleral patch graft and 65875 Posterior synechiae excision. They denied CPT code 67255 for the graft. Why was it denied?
    2. ICD-10 Code for Visually Significant Cataract 
      Current documentation only indicates “visually significant cataract.” What would the best ICD-10 code be?
    3. Billing for CyPass Stent 
      How do we bill for CyPass stent? Will the payer reimburse for this?
    4. ICD-10 for Secondary Glaucoma from Silicone Oil 
      Is there a diagnosis code for secondary glaucoma from silicone oil?
    5. ICD-10 Code for Bleb Leak 
      What diagnosis code should we use for a bleb leak after a trabeculectomy?
    6. Billing for ICL 
      A patient had an implantable contact lens procedure in March of this year. The lens is now causing problems, so our surgeon will exchange it. Can we bill this follow-up procedure to the payer?
    7. Multiple Tests Performed on Same Machine 
      When one machine performs more than one test, do we bill for each test separately?
    8. CPT Code for Pupillary Membrane Covering Pupil 
      I have a patient with a fibrotic pupillary membrane covering the small pupil and 360° posterior synechiae. I plan to remove the pupillary membrane, break the synechiae and form an adequate pupil opening. Which CPT codes should I use?
    9. Use of Viscoelastic for Complex Cataract Surgery 
      Our surgeon insists that the additional step taken to add extra viscoelastic suffices to support coding the surgery as complex case. The patient is noted to have a history of Flomax use. Is this acceptable?
    10. Lifetime Requirement for Corneal Pachymetry 
      Are we allowed to bill for CPT code 76514 Corneal pachymetry more than once?