• Coding Top 10: Hospital Consultation Billing, How to Bill for a House Exam


    Coding Top 10, July 2016

    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 practices.

    July's coding questions highlight billing topics ranging from hospital consultation billing, how to bill for services rendered in procedure room and how to bill for a house exam.

    1. CPT Code for Correction of Punctum
      The surgeon performed CPT code 67917 Repair of ectropion with tarsal strip. He also inverted the punctum, took a wedge out on the inside of the lid and then used a suture to turn the lid back in. What CPT code should I use to submit this procedure?
    2. How to Bill for Testing Glucose During Exam 
      We have a glucose monitor to check blood sugar during visits, when needed. I am unable to locate an allowable for this in the Medicare Part B fee schedule. Is there a specific code we should submit?
    3. How to Bill for a House Exam 
      Our physician performed an exam at a patient’s house. How do I bill for this?
    4. Timeframe to Bill for Correction of Surgical Induced Astigmatism
      A patient had cataract surgery three years ago and now needs surgery to correct astigmatism induced by the surgery. Some carriers seem to limit the timeframe for when we can perform the surgery. Can we bill the payer for the procedure or should it be the patient’s responsibility?
    5. Suture Removal Under General Anesthesia
      A patient received laceration repair of the upper lid. Outside the global period, the surgeon removed the sutures under general anesthesia. Can we bill for this?
    6. Exam Day Before Surgery 
      Our surgeon performed a corneal transplant the day after an exam. The payer reimbursed the surgery correctly, but denied the exam. Should I code the diagnosis for the exam something different from the procedure, or should I append a modifier?
    7. How to Bill for Services Rendered in Procedure Room 
      We are remodeling our practice and want to add a designated procedure room. Will payers reimburse at a higher rate for procedures performed in our room rather than a facility?
    8. HCPCS Code for PFO 
      Our surgeon injected purified perfluoro-n-octane liquid during the in-office procedure (CPT code 67025 Injection of vitreous substitute). What is the Healthcare Common Procedure Coding System code?
    9. Billing Bilateral Procedures 
      I performed bilateral CPT code 67145 Repair of retinal tear on a Medicare patient on the same day. The first claim I submitted was: 67145 –RT, 67145 –LT. When the payer denied it, I resubmitted: 67145 –RT, 67145 -LT-51. The payer also denied the second claim. What is the best way to submit for reimbursement?
    10. Hospital Consultation Billing 
      By request, our physician saw a patient at the hospital. Since the inpatient CPT codes are for the admitting physician, what should we use for this Medicare patient?