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    Coding Top 10: Billing for Tube Obstruction, Comanagement in Another State


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    Coding Top 10, June 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 June coding top 10 selections include:

    1. Injection Billing Sooner Than 28 Days
      We treated a patient with an anti-VEGF drug in the left eye. Two weeks later the patient returned for bilateral injections. The left eye drug was billed as $0.00 because it was free. However, the payer still denied the claim for the bilateral injection. Should we have submitted differently?

    2. Payment for Assistant at Surgery
      My surgeon was an assistant during a procedure with a retina specialist. The operative report clearly states why the assistant was necessary. However, reimbursement was minimal. Any guidance?

    3. Billing for Tube Obstruction
      What CPT code do I submit for YAG laser to tube with vitreous obstruction?

    4. Billing Interpretation of Fundus Photos
      In our rural community, primary care physicians are asking us to provide the interpretation and report on photos taken in their office for patients with known diabetic retinopathy to meet their Healthcare Effectiveness Data and Information Set (HEDIS) requirements. Isn’t this 92250 Fundus photography appended with modifier -26?

    5. Billing Patients for Repeat Surgeries in Global Period
      The doctor performs a surgery in which the CPT language states “one or more sessions.” The procedure must be repeated during the 90-day global period. Is it possible to have the patient pay for the second procedure after signing an Advance Beneficiary Notice (ABN)?

    6. Excludes1 Edits for Strabismic Amblyopia
      An Excludes1 edit in ICD-10 implies H53.03- Strabismic amblyopia can’t be billed to the same patient, same exam as any H50.- Strabismus diagnosis. Is that truly the case?

    7. Billing for Exam Instead of Minor Surgery
      Is it okay to bill for the level of exam rendered instead of a minor procedure performed the same day?

    8. Order for Sensory Test
      Is an order required if the tech performs the sensory test and the physician performs the measurements of alignment?

    9. Order of Modifiers
      Does the modifier order make a difference?

    10. Comanagement in Another State
      Can comanagement occur across state lines when there are different Medicare Administrative Contractors?