• Coding Top 10: New Patient Billing During Public Health Emergency, HOPD Prior Authorization Tracking Number, Charging Patients PPE Cleaning Fees

    Coding Top 10, August 2020

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    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 August coding selections include:

    1. New Patient Billing During Public Health Emergency
      During our office closure for COVID-19, a former patient of ours had multiple conversations with our on-call physician, none of which were submitted to insurance. She is now coming in for an exam. Because we have not billed an exam in over four years, is she considered new or established?

    2. Testing Determination from Phone Conversation with Patient
      We had a new patient speak with our physician prior to being seen. This was not a telemedicine exam. No claim was submitted. The physician determined that a visual field is needed. Would this test be considered a standing order as this is a new patient?

    3. Frequency of punctal plugs
      How often can we insert punctal plugs on a single patient? We have a patient requesting quick-dissolving plugs, which require reinsertion monthly.

    4. Billing for Smoking Cessation Counseling 
      I was made aware there are two CPT codes for smoking cessation counseling. Are they appropriate for ophthalmologists to use?

    5. Correct Units for Jetrea
      Our physician injected a patient with Jetrea for vitreomacular adhesion. I am confirming we submit three units.

    6.  ICD-10 Code for Inferior Oblique Overaction
      I am searching for an inferior oblique overaction ICD-10 diagnosis code.

    7. HOPD Prior Authorization Tracking Number
      We are performing a blepharoplasty in the hospital outpatient department and have received a provisional affirmation to proceed. Does the surgeon’s claim require the 14-digit UTN?

    8. CPT Code for Removal of Hydrus Stent 
      The facility is billing CPT code 65235 Removal of foreign body, intraocular; from anterior chamber of eye or lens for the removal of a hydrus implant. Is this correct?

    9. EUA Same Day and Lens Removal 
      Our pediatric surgeon performed an exam under anesthesia (EUA) along with removal of a cataract without implantation of IOL. We submitted the following but received a denial:
      66850 -RT
      How should we submit?

    10. Charging Patients PPE Cleaning Fees 
      We have heard that some dental practices are charging a personal protective equipment (PPE) cleaning fee. Are ophthalmologists allowed to charge a separate fee to patients?