November's coding questions highlight topics ranging from ancillary staff performing history component to how to code for corneal cross-linking and how to handle incident-to billing with staff optometrist.

1. Submitting CPT Code 67255 Same Day as 66180
   Q1. We billed two surgeries and received a denial for CPT code 67255 Scleral reinforcement (separate procedure); with graft. However, they paid CPT code 66180 Aqueous shunt to extraocular equatorial plate reservoir; external approach; with graft. How should I resubmit the scleral reinforcement?
2. How to Code for Corneal Cross-Linking
   Q2. Is there a CPT code for corneal cross-linking?
3. Aqueous Shunt Procedure Using Patient Sclera for Graft
   Q3. Our surgeon performed a shunt procedure and used the patient’s own sclera to create/place a graft. Would it be appropriate to submit CPT code 66180?
4. How to Handle Incident-to Billing with Staff Optometrist
   Q4. We employ several optometrists and independent contractors at our practice. Do they qualify as non-physician providers (NPP) for incident-to billing?
5. Can You Bill for Conjunctival Culture?
   Q5. Our physician obtained a culture from the conjunctiva. What CPT code do we submit?
6. How to Bill when Two Physicians Treat Same Patient, Same Day
   Q6. Can you charge an exam and/or test on the same day if the patient sees two ophthalmologists in the same practice? One specializes in glaucoma, the other cornea.
7. Additional Codes for Emergency Patient
   Q7. We recently treated a patient after hours as she got chemical powder in her eye and was in extreme pain. Our physician billed CPT code 99214 as well as a lavage of eyes and placed a bandage contact lens. Can we separately bill for the eyewash? Can we use a separate code for the emergency after-hours care?
8. Return Visit to See Technician for IOP Check
   Q8. A patient had a glaucoma visit with a documented plan to return in 30 days for an IOP check by technician. Can we bill for the return visit?
9. Ancillary Staff Performing History Component
   Q9. An internal auditor said technicians cannot complete the history component. Is the physician required to complete the history of present illness when billing E/M services?
10. Appropriate Modifier for Blepharoplasty
    Q10. We are submitting CPT code 15823 Blepharoplasty. However, it seems like there are multiple ways to submit. How should we submit to Medicare Part B and what would they reimburse?