• Coding Top 10: Patient Balance with Medicare as Secondary Payer, Lysis of Adhesions Along with Cataract Surgery and OTC Drug Order with Eye Visit Codes


    Coding Top 10, May 2019

    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 May coding selections include:

    1. CPT Code for Extraction of a Loa Loa Eye Worm
      What is the best CPT code for extraction of a Loa Loa eye worm from the subconjunctival space?

    2. Patient Balance with Medicare as Secondary Payer
      Our patient has Medicare as a secondary payer, which has a higher allowable than the commercial primary, leaving a patient balance. Do we collect this amount from the patient?

    3. Using New ERG Codes Same Session
      Are the new Electroretinography (ERG) codes bundled together?

    4. Lysis of Adhesions Along with Cataract Surgery
      Am I able to submit for lysis of adhesions separately from cataract surgery, or would this qualify for CPT code 66982 Complex cataract surgery?

    5. Explantation of Presbyopic Inlay
      Our surgeon needs to remove the presbyopic inlay due to complications. What is the best CPT code?

    6. Correct NDC When Wasting Photrexa Viscous
      It is my understanding that Photrexa viscous will not always be used during the procedure. When only the Photrexa is administered, would it be more appropriate to bill with NDC 25357-023-01 with J2787 as that is the more accurate NDC?

    7. CPT Code for Conjunctival Peritomy and Exploration
      Our surgeon plans to perform a conjunctival peritomy/scleral exploration due to a slow leak from a previous pars plana vitrectomy. The surgery will consist of making an incision in the conjunctiva and pulling back to explore the sclera, and possibly suture, if needed. Is there an existing CPT code that is appropriate?

    8. OTC Drug Order With Eye Visit Codes
      CPT language for comprehensive Eye visit codes indicate that at least one of the required items, such as “Prescription of medication” must be documented. Can the prescription be an over-the-counter drug?

    9. Manual Break of Posterior Synechiolysis
      Our physician manually broke a posterior synechiolysis between iris and lens. Is there an existing CPT code that is best, or would we use an unlisted code?

    10. Removal of DSEK
      What procedure code is appropriate for the removal of DSEK because the patient has endophthalmitis?