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  • Coding Top 10: CPT Code for Canalicular Exploration, Removal of Intraocular Foreign Body Requiring PPV


    Coding Top 10, December 2016

    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 practices.

    December's coding questions highlight topics ranging from CPT code for canalicular exploration to removal of intraocular foreign body requiring PPV and billing for bleb needling and an injection during same encounter.

    1. Billing Removal of Silicone Oil 
      Q1. For silicone oil removal by pars plana vitrectomy, can we bill CPT codes 67036 Vitrectomy, mechanical, pars plana approach and 67121 Removal of implanted material, posterior segment; intraocular? I feel 67121 is the most appropriate as a vitrectomy was previously performed. The doctor removed silicone oil due to complications.
    2. Billing for Procedures in the Emergency Department 
      Q2. Our surgeon saw a patient in the emergency department and billed 99284 Emergency department visit that includes a detailed history, detailed examination and moderate medical decision making. He also performed CPT code 65285 Repair of laceration; cornea and/or sclera, perforating, with reposition or resection of uveal tissue on the same day. Can we bill the surgical procedure as well?
    3. Reimbursement for Multiple Tests Performed During Same Encounter 
      Q3. If we perform a visual field, optic nerve OCT and pachymetry the same day, are we only reimbursed for one of the tests? Do payers reimburse only for the lowest allowable?
    4. CPT Code for Canalicular Exploration 
      Q4. Is there a CPT code for a canalicular exploration? Our surgeon performed canalicular exploration, irrigation and biopsy of the abscess.
    5. Removal of Intraocular Foreign Body Requiring PPV 
      Q5. The surgeon removed an intraocular foreign body due to a penetrating injury. It was also necessary to perform a pars plana vitrectomy. Can we unbundle CPT code 67036 Vitrectomy, mechanical, pars plana approach from CPT code 65265 Removal of non-magnetic intraocular foreign body?
    6. CPT Code for Contrast Sensitivity Testing 
      Q6. Can we separately bill contrast-sensitivity testing? We cannot find a CPT code.
    7. Anterior Segment Exam Same Day as Cataract Surgery 
      Q7. I performed an anterior segment exam, retinoscopy and A-scan, followed by complex cataract surgery, on a patient under general anesthesia. How should I submit this to Medicare?
    8. Visual Field Interpretations from Outside the Practice 
      Q8. Our physicians interpret visual field studies performed outside our office. When we bill for the interpretation, what should we put as the date of service: the date the study was done or the date of interpretation?
    9. Understanding Bundling Edits 
      Q9. When I look in the Academy’s Coding Coach: The Complete Ophthalmic Reference, it shows that CPT code 66984 Cataract extraction with IOL has a Correct Coding Initiative edit bundling in CPT code 67005 Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal. However, when we look up 67005, there is no bundle. Should we not bill both codes?
    10. Billing for Bleb Needling and an Injection During Same Encounter 
      Q10. How do I code a bleb needling with 5 Fluorouracil injection performed during the global period for the same eye?