MAR 22, 2018
Coding Top 10: ORA Billing and CPT Code for Cataract Removal Without Implant
Coding Top 10, March 2018
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The March coding top 10 selections include:
CPT Code for Cataract Removal without Implant
The physician removed a mature pediatric cataract, which required the use of trypan blue. The surgery involved an anterior approach using the vitrector, rather than pars plana capsulotomy. She did not insert an IOL as it was not indicated. What is the best CPT code?
Billing for Sample Drug
Our administrator told us to bill a sample medication as $0.01 along with the injection. Shouldn’t the charge be zero since we used a sample?
Reimbursement for Category III code 0464T
Can you refer us to the allowable for Category III code 0464T VEP for glaucoma?
Billing for Prescription Research
Sometimes when we order a prescription for patients, the pharmacy states it is not a covered medication and requires an alternative. This takes time to research. Can we submit a charge for this research?
Bundled New Patient Exam with Minor Procedure
We billed E&M code 99203 along with CPT code 65205 Conjunctival foreign body removal. The commercial payer stated the exam was included in the payment for the surgery. Is this correct?
Non-Covered Diagnosis for AMT Placement
The patient’s insurance plan does not cover the reason the patient needs CPT code 65778 Amnionic membrane transplant. Would insurance still cover the treatment if we believe it is medically necessary?
Billing for ORA
Our surgeons use optiwave refractive analysis for cataract surgery. Do both the surgeon and the facility charge for the service and what is the correct CPT code?
Usage of Modifier -52
I’ve read that if we perform a test on one eye, we need to append modifier -52, but I am not finding much data on this. Language I’ve read from the Academy states not to append. Can you clarify?
Billing Exams Without Insurance Credentialing
We have a new physician joining our practice sooner than her license is available and prior to credentialing. Can we bill under the group with a specific modifier? I heard about locum tenens.
Keratoplasty Codes Impacted by Natural Lens
When billing a keratoplasty for patients requiring a corneal transplant, does it matter if the patient is phakic or pseudophakic?