• Coding Top 10: Goniotomy and Other Glaucoma Surgery Same Day, Epilation Sooner than Eight Weeks and New Diagnosis Prompting Another Injection Less than 28 Days

    Coding Top 10, March 2019

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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. Goniotomy and Other Glaucoma Surgery Same Day
      Is it appropriate to report CPT code 66174 for therapeutic dilation of Schlemm's Canal and code 65820 for a goniotomy when these two procedures are performed on the same eye to treat glaucoma?
    2. Complete Review of Systems When Not Pertinent to Exam
      If a technician or physician is unable to perform a complete review of systems because they are not pertinent to today’s exam, can he receive full credit for stating all others are not pertinent to the patient’s condition?
    3. Billing for Post-Cataract Glasses
      There is a discrepancy between our office and a referring office as to how Medicare handles a change in glasses post cataract extraction. Is the patient obligated to have both eyes operated on before Medicare will allow for bilateral lenses?
    4. Language for Chief Complaint
      We recently obtained a satellite office that uses “vision stable” as the chief complaint for established glaucoma patients. Is this acceptable?
    5. Reporting Wastage in Box 19 on Claim Form
      Should we report what was injected in the eye only, or if there is reportable wastage, do we include this number in box 19?
    6. Epilation Sooner than Eight Weeks
      We have a patient that returns frequently for epilation. He would like to come sooner than eight weeks and feels that it is medically appropriate. We did bill and received a denial due to frequency from Medicare. How do we get this paid?
    7. ICD-10 code for Corneal Scar Status-Post Laceration
      We have a patient who is status-post corneal laceration and now has scarring. What is the best ICD-10 code to use as we are unsure about sequela codes?
    8. CPT Code for Multiple Molluscum Lesions
      We have a 2-year-old who had molluscum lesions on each upper eyelid, as well as on his face and body which was 18 total lesions. The parents asked if our surgeon would remove all, and he did. How best do we submit this service?
    9. CPT Code for I&D of Chalazion
      What is the appropriate CPT code for incision and drainage of a chalazion instead of excision?
    10. New Diagnosis Prompting Another Injection Less than 28 Days
      I treated a patient with Eylea in the right eye for diabetic macular edema. Two weeks later she developed a retinal vein occlusion with macular edema in the same eye, so I injected Lucentis. Since there is a new diagnosis and the drug has been changed, will the fact that she received two injections in the same eye less than 28 days apart be problematic?