• Coding Top 10: Inpatient Consultation Billing, Collection of Patient Deductables and CPT Code for Eyelid Cyst

    Coding Top 10, February 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 February.

    February's coding questions cover several subspecialties, from cataract/anterior chamber to retina and topics from inpatient consultation billing, collection of patient deductables and CPT code for eyelid cyst.

    1. CPT code for "piggyback IOL" insertion 
      In June, my surgeon inserted a “piggyback” IOL in the right eye of a patient that had cataract surgery. Is there a CPT code for this?
    2. CPT code for manual iridoplasty 
      The doctor performed cataract surgery along with a manual iridoplasty. Is the manual iridoplasty separately billable? If so, what is the appropriate CPT code
    3. Inpatient consultation billing 
      Our physician saw a Medicaid patient in the hospital and submitted CPT consultation code 99254 which was processed appropriately. While still inpatient our physician saw the patient a second time for a corneal ulcer and submitted CPT consultation code 99251. Our claim is disallowed stating a new patient consult was billed for an established patient. What code should we use?
    4. Collecting patient deductibles 
      When is it appropriate to collect the deductible/ coinsurance from a patient? We have heard that we can no longer collect at the time of the service?
    5. Using modifier -24 frequently
      I use modifier -24 quite frequently when I bill exams in the postoperative period for unrelated services. Will using this modifier often raise a potential red flag?
    6. CPT code for eyelid cyst when incision and drainage (I&D) is performed 
      Can CPT code 67840 Excision of a lesion of eyelid, be used when we just incise and drain an inclusion cyst?
    7. CPT code for vitrectomy with silicone oil removal 
      The physician performed a vitrectomy and also removed silicone oil. We billed CPT codes 67036 and 67120; however we were only paid for CPT code 67120. Before we appeal, can you confirm if we billed this claim correctly?
    8. Testing services denied during inpatient stay 
      Medicare Part B is not allowing for our testing procedures (CPT code 92083 Visual Field and CPT code 92250 Fundus photos) while the patient was an inpatient in the hospital. The office exam was paid, however, I would like to see if I should be billing these tests to the payer or the hospital? 
    9. Payment reduction for multiple testing services
      Our remittance advice from Medicare shows they added modifier - 51 to some of our technical component line items. When I called Medicare for an explanation I was told this was an “Ophthalmology service reduction for multiple line items”. What does that mean and is this appropriate?
    10. Frequency of a gonioscopy exam 
      How often can I repeat a gonioscopy exam?