• Coding Top 10: ORA Billing and CPT Code for Cataract Removal Without Implant


    Coding Top 10, March 2018

    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.

    The March coding top 10 selections include:

    1. 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?

    2. 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?

    3. Reimbursement for Category III code 0464T
      Can you refer us to the allowable for Category III code 0464T VEP for glaucoma?

    4. 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?

    5. 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?

    6. 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?

    7. 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?

    8. 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?

    9. 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.

    10. 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?