• Coding Top 10: Dilation for E/M Codes, Advanced Glaucoma Testing and Postoperative Exams When Self Pay


    Coding Top 10, June 2019

    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.

    Get trusted answers to your coding questions from the Academy’s coding experts, so you can bill and code with confidence. The June coding selections include:

    1. CPT Code for Triton OCT
      I am confirming the CPT code to use for the Triton OCT.

    2. Postoperative Exams When Self Pay
      When a self-paying patient has medically necessary surgery, are postoperative exams included or separately billed?

    3. Dilation for E/M Codes
      Our billing department has stated dilation is only necessary for eye visit codes, but not E/M codes. Is our pediatric ophthalmologist not required to dilate when billing 99214?

    4. Surgery Without Office Exam
      One of our surgeons is injured and unable to perform cataract surgery. Is another surgeon of the practice able to perform surgery without seeing the patient in the office?

    5. Billing Fluorescein Separately from Test
      Can we bill injectable fluorescein separately from CPT code 92235 Fluorescein angiography?

    6. Botox Injection into Lacrimal Gland
      Our surgeon injected Botox into the lacrimal gland due to epiphora. Is there a CPT code to submit or is the patient responsible?

    7. EUA During Cataract Surgery
      Our surgeon performed cataract surgery on a Down syndrome patient. During the surgery he performed an exam under anesthesia (EUA) due to the patients cognitive and emotional limitations. Previously, we have billed CPT code 92499 to bill the exam under anesthesia. We are confirming billing and modifier application?

    8. Advanced Glaucoma Testing
      When patients have advanced glaucoma, what testing can be performed? We’ve been told in the past testing would be denied.

    9. Dedicated Procedure Room Requirements
      What are the requirements for having a dedicated procedure room in our practice?

    10. Dilation Pertaining to Review of Systems
      Our physician was told that regardless if the patient is new or established, that you need at least 10 review of systems records documented if the patient is dilated. Is this true?