• Coding Top 10: Medicare H&P Guidelines, Multiple iStents and Bilateral Fluorescein Angiographies

    Coding Top 10, January 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 January.

    January's coding questions cover subspecialties, from glaucoma to retina, and topics from H&P guidelines for Medicare to multiple iStents in one session and billing bilateral fluorescein angiographies.

    1. Multiple iStents in one session 
      If multiple iStents are inserted at the time of cataract surgery, how do we code for and get paid for the additional iStents?
    2. Separate billing of punctal plugs 
      I know that Medicare Part B includes the supply of the punctal plugs with the insertion. Do other payers follow that same rule?
    3. Billing bilateral fluorescein angiographies 
      When pathology is in both eyes how should a bilateral fluorescein angiography be submitted? Should it be as a single line item with modifier -50 or two lines with –RT and –LT?
    4. Records request for Lucentis injections 
      For the past 6-8 weeks or so, we have received records requests for all Lucentis injections done for Medicare patients.  I hope this doesn’t continue or start to include other drugs?
    5. Scribe signature requirement 
      I had a prepayment review for CPT code 99204.  Our EHR note has the physician’s electronic signature and a typed notation that has a place for the scribe’s initials.  The visit was denied because it didn’t meet the scribe signature requirement.  Should the scribe have an electronic signature on the chart as well.  Can I appeal this if I send a signature log with my appeal?
    6. Medicare coverages rules for patients in a skilled nursing facility (SNF) 
      We billed Medicare part B for HCPCS code J0178.  Medicare paid and then later recouped their payment stating that the patient was in a skilled nursing facility (SNF) at the time of the injection?
    7. Payment denials from commercial plans for office-based surgical procedures 
      We have been denied payment from commercial plans for office-based surgical procedures such as strabismus surgery and vitrectomy.  We submitted a reconsideration, which was also denied.  Medicare covers the office-based surgeries, why doesn’t the commercial plan?
    8. H&P guidelines for Medicare 
      Can someone direct me to the place where I can find Medicare guidelines when it comes to the H&P prior to surgery?
    9. Testing While Patient has Hospital Inpatient Status
      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?
    10. Gas bubble injection to displace blood 
      Our physician injects a gas bubble into a patient’s eye trying to displace blood.  He states it is not a pneumatic retinopexy.  What is the appropriate CPT code?