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

1. Unbundling Goniosynechialysis with Cataract Surgery
   Is it appropriate to unbundle CPT code 65865 Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); goniosynechiae, with cataract surgery?

2. ICD-10 Code for Failed Vision Screening
   Is there an ICD-10 code for failed vision screening?

3. Billing Plugs to Commercial Payer
   While Medicare bundles punctal plugs into the insertion code, I thought commercial payers pay separately, however A4263 for silicone, is being denied. Is there another code we should bill?

4. Bleb Revision in Office
   Can a bleb revision be performed in the office setting?

5. ICD-10 Code for Orbital Roof Fracture
   Is there a diagnosis code for orbital roof fracture?

6. CPT code 15004 Denied by Medicare
   Our surgeon performed and billed for CPT code 67966 Excision and repair of eyelid, along with 15004 Surgical preparation of recipient site. Medicare denied 15004. The surgeon feels this is incorrect. Should we have billed this differently?

7. CPT Code for Globe Exploration
   Our surgeon performed an exploration of the left globe on a patient who was thought to may have a ruptured globe due to blunt trauma, but fortunately none was found. The surgeon did not explore the orbit, only the globe. What CPT code should be billed?

8. Excludes1 Edits Now Being Applied
   There is an Excludes1 edit that states H50. strabismus codes cannot be submitted with H53. amblyopia codes for the same service. We are now seeing denials where previously payers were allowing us to bill both diagnoses. How should we go forward?

9. Consultation for Retinal Detachment
   When the payer still recognizes consultation codes, should we use them when an optometrist sends a patient to us after a retinal detachment was discovered?

10. Audit Tool Applied to Eye Visit Codes
    Our compliance department is in the process of reviewing our new patient Eye visit codes, and they are down-coding our comprehensive codes to intermediate, as we are missing the review of systems and past, family and social histories. Do we need to have this documentation?