• Coding Top 10: Exams for Relatives, Capsular Phimosis and Paracentesis

    Coding Top 10, April 2016

    Ask the Academy Coding Experts is a new 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. We have provided the top 10 questions received for April.

    April's top ten coding questions highlight topics ranging from billing paracentesis during cataract surgery, how to code capsular phimosis and exams for family members.

    1. Bilateral Test Performed with Pathology Only in One Eye 
      The doctor performed an extended ophthalmoscopy bilaterally and determined the patient has central serous in the left eye only; no pathology in the right eye. Can we still bill for the right eye test since it was performed?

    2. Exams for Family Members 
      Our physician’s husband had cataract surgery performed by another surgeon, but she will manage her husband’s postoperative care. Which modifier(s) do we append for payment of the global period?

    3. How to Code Capsular Phimosis 
      How do I code for capsular phimosis and bill for an anterior capsulotomy?

    4. CPT Code for Eyelash Removal in Conjunctiva
      The physician removed an eyelash that was embedded in the conjunctiva and said to bill the procedure as a foreign body removal. Is this correct?

    5. CPT Code for Suture Removal
      I saw a patient today on an urgent basis with complaints of redness, discharge and pain. Exam revealed a broken suture in the conjunctiva, which I removed. The patient had undergone muscle surgery by another surgeon two weeks ago. Can I bill the suture removal, or just the exam?

    6. Appropriate Billing for Double Pterygium 
      When the patient has a double pterygium, is it appropriate to submit CPT code 65426 Excision of pterygium; with graft with 2 units and LT modifier to Medicare Part B?

    7. Billing for Hospice Patients
      If we see a Medicare Part B patient, who is now enrolled in hospice, for continuation of eye care, how should we submit the claim?

    8. ABN for Oculofacial Procedures
      I was told recently that we should obtain an ABN for lesion removals for Medicare Part B patients. Is it also recommended for blepharoplasties, even if they are functional?

    9. CPT for Optomap
      How should I submit claims when using the Optomap?

    10. Billing Paracentesis During Cataract Surgery
      Whenever our doctors perform a cataract surgery, they also do a paracentesis. According to CCI edits, CPT code 66984 Cataract extraction with IOL and CPT code 65800 Paracentesis are not bundled. Should we submit both codes for the day of surgery? Second question: Many times they depress on the post-surgery excision to let fluid out to decrease the pressure if the pressure is too high. Does this also meet the criteria for submitting CPT code 65800 Paracentesis?