• Coding Top 10: Billing for Removal and Reperformance of Tarsorrhaphy, IOL Exchange for Unhappy Patient

    Coding Top 10, July 2018

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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 top 10 selections include:

    1. Billing for Contact Lens Fitting for Ocular Surface Disease
      How many times can I bill for 92071 Fitting for bandage contact lens? We see the patient monthly due to painful bullous keratopathy.

    2. Billing for Removal and Reperformance of Tarsorrhaphy
      I have a young boy with CN 5, 6 and 7 palsies. He is coming to me for repair of his strabismus with medial rectus contracture secondary to longstanding esotropia from CN 6 palsy. He previously required a permanent lateral tarsorrhaphy for management of a neurotrophic corneal ulcer from CN 5 and 7 palsies. In order to perform the surgery, I plan to undo the tarsorrhaphy for adequate exposure to perform a medial rectus recession and superior and inferior rectus transpositions. I will then need to reperform the tarsorrhaphy. Would it be appropriate in this case to bill for a severing and performing a permanent lateral tarsorrhaphy in addition to my strabismus surgeries?

    3. Payment for Usage of Modifiers -62 or -80
      Is there a reduction in payment if an assistant-at surgery is used versus a co-surgeon?

    4. Usage of Review of Systems for Eye Visit Codes
      Do we need to have a review of systems for a comprehensive exam billed as an Eye visit code?

    5. Billing Self-Pay Instead of Insurance
      If patients choose to pay out-of-pocket for their exams rather than bill their insurance, do we have to limit what we charge them?

    6. Billing for Healon Injections
      We have a patient transferred to us for continued injections of Healon .85mg. The patient is refusing enucleation, so Healon is being used as a way to keep the eye inflated. I have been told to use J7317 for Healon, however this appears to be for osteoarthritic treatment for knees. Do we submit for Healon?

    7. Billing for ReSure Sealant
      Can we bill for ReSure Sealant if needed after cataract surgery?

    8. IOL Exchange for Unhappy Patient
      The patient had cataract surgery, and everything turned out perfectly. Unfortunately, the patient is not happy and now wants uncorrected near vision, not remembering all the discussion preoperatively that took place regarding our targeted PO refractive endpoint. Do we bill insurance when we achieved our goal, however unsatisfied the patient?

    9. Billing for Time with Parents
      Parents came in to see our physician asking questions pertaining to strabismus surgery without the patient being present. Is there a code we can submit?

    10. Billing for Trabectome
      Is there a CPT code we can bill for Trabectome?