• Coding Top 10: CPT Codes for Unscheduled Patients, Appropriate Billing of Postoperative Exams

    Coding Top 10, September 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.

    September's coding questions highlight topics ranging from CPT codes for unscheduled patients and appropriate billing of postoperative exams.

    1. Appropriate Billing of Postoperative Exams
      Our physician’s schedule is quite full and there are times when we are unable to see post-surgical patients during the global period. Can we bill for an exam if the first post-surgical visit is outside the global period?
    2. Denial for Fitting of Bandage Contact Lens
      Our practice keeps receiving denials for the fitting of bandage contact lens. We submit CPT codes 99213 -25, 65435 –RT Removal of corneal epithelium and 92071 –RT Bandage contact lens fitting for these services. Medicare keeps paying the exam and procedure only.
    3. Timing of Postoperative Period
      Does the global period start from the comprehensive examination date or the surgical date?
    4. Appending Modifier to Injections
      I recently heard we should add a modifier to injection code 67028 when the physician performs it bilaterally. Do I need modifier -50 indicating bilateral or modifier -RT and -LT?
    5. Related Exams During Global Period
      A patient with punctal plugs came back within 10 days with the same complaints. We submitted 92012 with modifier -24 for the same diagnosis. The payer denied the claim, stating that the procedure payment includes this. Do I need to change the diagnosis?
    6. Postoperative Complication Billing
      I have a case where the physician performed cataract surgery without complication. On the first postoperative day, the patient developed a significant wound leak. The patient came in and the physician sutured the incision in the operating room. How should we submit this?
    7. CPT Codes for Unscheduled Patients
      Is there a specific code for seeing patients as an unscheduled work-in during or after-hours?
    8. Co-Surgeon Billing of IOL Repositioning
      In conjunction with the cataract surgeon, I performed a pars plana vitrectomy and participated in retrieval and repositioning of the IOL. When I billed for this, I received a denial from the payer stating the diagnoses do not apply. Can you assist? I submitted CPT codes 67036 –RT and 66825 -62 -51 –RT.
    9. Medical Diagnosis with Refractions
      We find some payers cover a refraction annually with a medical diagnosis. Should our practice submit medical or vision diagnoses on refractions?
    10. Bundling YAG Vitreolysis and Capsulotomy
      I am trying to determine if CPT code 67031 YAG vitreolysis is bundled into CPT code 66821 YAG capsulotomy and have been unable to find the answer