• Coding Top 10: Postoperative Management within Same Practice, Emergency Department Exam Billing

    Coding Top 10, May/June 2017

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    The May/June coding top 10 selections include postoperative management within same practice, emergency department exam billing and multiple lesion removal versus chalazion.

    1. Emergency Department Exam Billing
      Our physician saw an established patient in the emergency department. The patient was discharged and we are now following up in our office suite. How do I bill for the ED visit?
    2. Postoperative Management Within Same Practice
      Should we use modifiers -54 and -55 if another physician in the same practice manages the patient’s postoperative period?
    3. Chart-Note Completion Deadline
      Is there a rule stating that the chart note must be completed within a certain number of hours of the exam’s completion?
    4. New Patient Requiring Blepharotomy
      Over the weekend, our surgeon treated a new patient with a very large abscess on his eyelid that was incised and drained at this visit. I plan to submit CPT code 67700 Blepharotomy. However, I am unsure about billing an office visit. What should I submit?
    5. Multiple Lesion Removal Versus Chalazion
      Our surgeon performed CPT code 67840 Excision of lesion of eyelid. However, the surgeon removed multiple lesions. Shouldn’t this be submitted as CPT code 67801 Excision of chalazion multiple same lid? The procedure note states: Excision of multiple lid lesions left eyelid - left upper eyelid, left temporal, center, top inferior and bottom inferior.
    6. Payer Bundling Gonioscopy
      We have a payer who states a gonioscopy is incidental to an extended ophthalmoscopy. I don’t see a Correct Coding Initiative edit. Has something changed?
    7. Testing Order Requirement
      To bill for CPT code 76514 Corneal pachymetry, do we need to have a documented order in the medical record?
    8. Postoperative Management for iStent
      Medicare instructed us not to use the co-management modifiers on Category III code 0191T iStent. What about the cataract surgery billed in conjunction?
    9. Billing Multiple Procedures
      The doctor performed bilateral lateral recession with adjustable sutures on a patient who previously had muscle surgery. He also performed bilateral exploration of each inferior oblique. He noted in the operative report a separate conjunctival defect/hole that he repaired with sutures. How do I code for these procedures?
    10. Exam Coding for Systemic Diseases
      Do you recommend using an Eye visit code or E&M codes for payers? I understand I cannot use rheumatoid arthritis as a diagnosis with an Eye visit code.