• Coding Top 10: Billing Patients for Repeat Surgeries in Global Period, Dye Usage in Cataract Surgery

    Coding Top 10, January 2018

    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.

    The January coding top 10 selections include:

    1. Glaucoma Diagnoses for Anterior Segment OCT
      If our doctor performs CPT code 92132 Anterior Segment OCT for evaluation of anatomical narrow angles or narrow angle glaucoma, what diagnosis do we use?

    2. How to Bill for Same Test Performed Same Day 
      Our optometrist saw a patient for flashes and floaters, then referred the patient to the practice’s retina surgeon on the same day. Later that day, the retina specialist examined the patient, performed extended ophthalmoscopy and did surgery to repair a retinal detachment repair. How do we bill for the extended ophthalmoscopy?

    3. CPT Code for Embedded Lash
      Our surgeon extracted an embedded lash, making an incision to release the lash. What is the best CPT code for this procedure?

    4. Dye Usage in Cataract Surgery
      I see conflicting language regarding the usage of Trypan Blue when billing complex surgery for a mature cataract. Can you confirm whether or not it meets the criteria for complex cataract surgery?

    5. Bilateral Eyelid Lesion Removal
      How should we bill a commercial payer for bilateral lower-lid lesions with CPT code 67840?

    6. Conjunctival Laceration Repair in the ER
      I treated a patient in the emergency department, who hit his eye with needle-nose pliers. The exam revealed a conjunctival laceration. I carefully removed four eyelashes from under the conjunctiva and checked to see if there was a ruptured globe. How should I submit this?

    7. Confirming ICD-10 Code for Botox Injections
      Our surgeons inject Botox for several reasons. The payer denied our claim for one specific case. We submitted CPT code 64612 along with J0585 for G24.3 Spasmodic torticollis. Can you help me understand the denial?

    8. CPT Code for Raster OCT
      Is there a billable CPT code for Raster OCT (macula)?

    9. Billing for Exam Instead of Surgery
      If I perform a minor procedure that has less reimbursement than the level of exam performed, can I bill for the exam rather than the minor procedure?

    10. Billing Patients for Repeat Surgeries in Global Period
      Say the doctor performs a surgery with the language one or more sessions – and must repeat the procedure during the global period. Is it possible to have the patient pay for the second procedure after having him or her sign an advance beneficiary notice?