• Coding Top 10: Frequency of Retina OCT, Frequency of Billing Fundus Photography and Superglue to Eye


    Coding Top 10, March 2020

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

    1. Frequency of Retina OCT
      We are receiving many denials for CPT code 92134 Retina OCT due to frequency. However, our office hasn’t performed the test in two months. Should we appeal?

    2. 92201 Requiring Scleral Depression
      Is scleral depression required for 92201?

    3. Surgery Rejection with Modifier -24
      One day post-op following cataract surgery on a Medicare patient, the surgeon performed bilateral punctal occlusion with plugs. We billed the appropriate level of exam with modifier -24, indicating the exam was unrelated to the cataract surgery, but the claim was denied. Is there another modifier we should submit?

    4. Unsuccessful Probing of Nasal Lacrimal Duct
      Our surgeon dilated and probed the patient’s right lacrimal duct. However, the probing was unsuccessful. Should we submit CPT code 68810 Probing of nasolacrimal duct, with or without irrigation, with modifier -52 for reduced services?

    5. Frequency of Billing Fundus Photography
      Our physician heard that he should not be submitting CPT code 92250 Fundus Photography more than twice per year. However, he feels there are times when additional billings may be necessary. Can you confirm the frequency of billing fundus photos?

    6. Orders for Diagnostic Imaging Tests
      I’ve read there are new diagnostic imaging test requirements that must be met for referring physicians. What do we need to do to be following Medicare’s Clinical Decision Support (CDS) mandate?

    7. On-call Patients Seen on Weekend
      Our physician treated a patient over the weekend while on call for another practice. Can we bill CPT codes 92004 and 99050 Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (e.g., holidays, Saturday or Sunday) in addition to basic service?

    8. Superglue to Eye
      Our patient got superglue in their right eye. Our physician examined the patient and debrided the lashes. What CPT code is billed for the removal of glue from lashes?

    9. Reduction in Payment for Higher Allowable Procedure
      When performing cataract surgery and goniotomy at the same session, I append modifier -51 to cataract surgery, as it has a lower allowable. However, our Medicaid plan has a higher allowable on the cataract surgery, so I append the goniotomy with modifier -51. We received our remittance advice and noticed payment was reduced by 50% on the cataract surgery. Are they allowed to switch the placement of the modifier?

    10. Billing Corneal Hysteresis
      Our practice just acquired equipment for corneal hysteresis. Can you tell me the appropriate CPT code to bill?