• Coding Top 10: Billing for Injection Related to Pterygium Surgery, Billing Exams in the Global Period and Resolved Diagnosis Follow-Up

    Coding Top 10, July 2019

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    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.

    Get trusted answers to your coding questions from the Academy’s coding experts, so you can bill and code with confidence. The July coding selections include:

    1. Billing Serum Tears
      Is the office preparation of serum tears billable to insurance?

    2. Injection Code for Yutiq
      What injection code is billed for Yutiq?

    3. Ganglion Cell Analysis
      For a ganglion cell analysis for glaucoma, should the CPT code be 92133 or 92134?

    4. Referring Patient to Partner During Global Period
      Our patient is in the global period for cataract surgery, and it’s been determined she has cystoid macular edema (CME). We referred her to a retina specialist n our practice. Is the exam billable with modifier -24?

    5. Resolved Diagnosis Follow Up
      A patient has been seen for the last three visits for the same diagnosis. However, today the condition is resolved. Can we bill the same diagnosis?

    6. Surgeon Treating Patient in Co-management
      A patient is being co-managed for cataract surgery and has now returned to the surgeon for a related complaint. Is the surgeon able to bill for the exam? 

    7. Billing Exams in the Global Period
      A patient 60 days into the global period for cataract surgery has been diagnosed with a post-vitreous detachment (PVD), which may or may not be related. The physician feels this should be billable. Should we append modifier -24?

    8. Determining Risk for Immature Retina
      When billing E&M services, for a baby with immature retinas, what level of risk would be used? There was no retinopathy of prematurity (ROP) detected.

    9. Visual Field Billing for Lid Surgery
      We billed 92083 Visual field to a commercial payer with a diagnosis of dermatochalasis and were paid, but our billing manager stated this visual field should not have been submitted.

    10. Billing for Injection Related to Pterygium Surgery
      For the purpose of disrupting the vascular supply to the pterygium to prevent further growth and to reduce any potential damage to the cornea during the excision, our surgeon wants to inject mitomycin C first, followed by excision at another date. What is billable other than the pterygium excision?