JUN 24, 2016
Coding Top 10: Cataract Surgery Without IOL Implantation, How to Use Modifier -JW
Coding Top 10, June 2016
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June's coding questions highlight topics ranging from cataract surgery without IOL implantation, denial of gonioscopy same day as other services and using modifier -JW correctly.
- Bilateral Extended Ophthalmoscopy Allowable
When submitting 92226 –RT Subsequent ophthalmoscopy and 92226 –LT, the commercial payer is changing it to 92226- 50 and reducing payment to 100 percent instead of 200 percent. Should we appeal?
- Billing Exam Same Day as OCT and Injection
When billing for an established patient exam along with OCT and injection, are all three payable?
- Treatment of Ocular Hypertension Same Day as Injection
If a patient is scheduled for an Avastin injection and the physician also treats ocular hypertension, is the exam billable?
- Usage of Modifier -58
How do I determine if a procedure requires modifier -58 pertaining to lesser to greater?
- How to Know When You Can Unbundle
What is the path to unbundling? How is it determined?
- Performing Two Procedures Same Day
What modifiers are required when performing both CPT code 67210 Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; photocoagulation and CPT code 67028 Intravitreal injection in the same eye?
- Modifier -53 and Testing Services
When performing CPT code 92235 Fluorescein angiography or CPT code 92240 ICG and a vein is unobtainable, can we append a modifier for the supplies that were used?
- Using Modifier –JW Correctly
How do you document waste for a single-use vial? How is modifier -JW used properly?
- Denial of Gonioscopy Same Day as Other Services
We received a denial from a commercial payer on CPT code 92020 Gonioscopy. It was submitted along with CPT code 92012 -25 and CPT code 66761 LPI. Were they correct in their denial or should we appeal?
- Cataract Surgery Without IOL Implantation
The physician discontinued cataract surgery after a pressure spike and the lens was removed, but did not implant an IOL. Three weeks later the IOL was inserted. What is the correct way to code the two procedures?