• Coding Top 10: Billing for Emergency Cancellation of Surgery and Coding for Gold Weight Removal

    Coding Top 10, April 2018

    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.

    The April coding top 10 selections include:

    1. How to Code IOL Removal, New Implant
      Our surgeon removed a dislocated IOL that another surgeon implanted. Then he implanted a new lens. He suggested we bill:
      • 65265 -RT Foreign body removal, nonmagnetic;
      • 67036 -RT Pars plana vitrectomy; and
      • 66985 -RT Secondary IOL implant.
        Is this submission correct?
    1. Billing for Emergency Cancellation of Surgery
      We saw a patient in our ASC for surgery. During the preoperative administration of medication, his hypertension presented a complication where we couldn't get his blood pressure under control. Instead of surgery, we had to send him to the emergency department. Can the facility submit for the surgery even though it did not take place?
    2. Coding for Gold Weight Removal
      How do I code for gold weight removal?
    3. Supervision Requirements for Retinal OCT
      My Medicare fee schedule states that supervision rules do not apply to retinal OCT. I thought this test fell under general supervision?
    4. Billing for YAG Laser In-Office
      We’re going to bring YAG lasers in-office. Is there an additional code we submit to payers?
    5. Billing for 2 Shunts in the Same Eye
      The payer denied CPT code 66185 Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft when billed on separate lines for both superior and inferior tubes in the right eye. Should we have submitted with modifier -50 instead?
    6. Global Period of CyPass
      When performing Category III code 0474T CyPass, what is the global period?
    7. Billing Unilateral Services with Bilateral Diagnoses
      Commercial payers denied our services when we appended modifiers -RT or -LT, but the diagnosis is a bilateral code. Should we appeal?
    8. ICD-10 Code for Conjunctival Laceration Without Corneal Abrasion
      We recently had a patient who suffered a conjunctival laceration, left eye, without a corneal abrasion. The only diagnosis code we could find, S05.02XA, seems to include a corneal abrasion with the laceration. Is this the correct code?
    9. Patient Consult in Hospital Same Day as Injection
      Our physician was referred a child due to bilateral uveitis. Two weeks later, the patient had planned bilateral injections of Kenalog in the hospital. He was admitted for unrelated reasons and later that day the surgeon, who happened to be the on-call physician for the group, was asked for a consult for the same patient. The complaint was due to decreased vision bilaterally; however the only diagnosis was uveitis. Can we submit for the consult?