• Coding Top 10: Moderate Decision Making for Medically Necessary Surgery, Billing Telemedicine Emergency Exam and Follow-up, Billing Injectables to Skilled Nursing Facility


    Coding Top 10, March 2021

    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.

    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. CPT code for Meibomian Gland Expression
      Is there a code for meibomian gland expression?

    2. Bilateral Billing for B-scan
      With the change in descriptor for CPT code 76513, do we need to perform the test bilaterally?

    3. Additional Fees For Monovision IOL
      For patients choosing monovision as part of cataract surgery, extra calculation is necessary. Are we able to bill the patient for this service?

    4. Moderate Decision Making for Medically Necessary Surgery
      When any surgery is determined to be medically necessary, such as cataract surgery or entropion, but the patient defers surgery, are we still able to meet moderate medical decision-making?

    5. Billing 99215 for Same Day Exam as Surgeon
      If our physician determines a patient has a retinal detachment and refers the patient to a retina surgeon on the same day, should we submit 99215?

    6. Prescription Definition for Medical Decision Making
      Will refraction or contact lens prescription count as moderate for medical decision-making?

    7. Billing Telemedicine Emergency Exam and Follow-up
      Are we able to submit a telemedicine exam for a medical emergency on the weekend and then have the patient come into the office the following Tuesday and submit an office exam?

    8. Billing CPT code 99058
      We have never submitted CPT code 99058 Service(s) provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service for patients seen when our local hospital refers them. How should we submit?

    9. Patient Fees During Global Period
      For exams, tests or surgeries that are submitted to the payer during the global period, does the patient have out-of-pocket expenses associated?

    10. Billing Injectables to Skilled Nursing Facility
      Since Medicare states it will not reimburse for injected drugs while the patient is in a skilled nursing facility (SNF), do we bill the full amount to the facility?