• Coding Top 10: Unrelated Exam Day before Planned Surgery, Place of Service for Inpatient Status

    Coding Top 10, November/December 2017

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    The November/December coding top 10 selections include coding for an unrelated exam the day before planned surgery, place of service for inpatient status and payer guidelines for comanagement.

    1. CPT Code for Removal of Tension Ring
      If a surgeon removes a dislocated posterior chamber intraocular lens and a capsular tension ring, is there a separate CPT code for each removal?
    2. Billing for EDTA
      My physician is performing CPT code 65436 Removal of corneal epithelium with application of chelating agent (EDTA) in our ambulatory surgical center. Can we bill separately for the EDTA?
    3. ICD-10 Code for Pseudophakic Bullous Keratopathy
      I do not see a diagnosis code for pseudophakic bullous keratopathy. Should I bill H59.01X Keratopathy (bullous aphakic) following cataract surgery and Z96.1 Pseudophakia?
    4. Unrelated Exam Day Before Planned Surgery
      A patient is having a pre-scheduled Yag laser today. We saw her yesterday, as a work-in for a subconjunctival hemorrhage. Does that work-in visit need a modifier since it was yesterday?
    5. ADL Form Per Eye
      For the activities of daily living questionnaire prior to cataract surgery, should we have one per eye?
    6. Place of Service for Inpatient Status
      We received a denial of our comprehensive Eye visit code due to place of service and determined that the patient’s status was inpatient rehabilitation. Should we submit a corrected claim with POS 61?
    7. Additional Service for Foreign Body Removal
      Our surgeon performed a conjunctival foreign body removal in the ambulatory surgery center. This was previously attempted in the office setting, however the patient passed out. Since the conjunctiva healed over, the surgeon was required to cut that portion out as well as cauterize the area. Can we use another CPT code?
    8. Exam Prior to YAG
      Is it required that the surgeon perform a complete dilated exam prior to scheduling a procedure such as a YAG capsulotomy? I have heard that the referring physician can schedule the patient for a procedure without the surgeon seeing the patient first.
    9. Payer Guidelines for Comanagement
      When pterygium excision is performed, and the payer does not recognize the comanagement modifiers, is there a way for the comanaging physician to get reimbursed?
    10. Billing Comanagement
      How do we submit the claim when we are comanaging CPT code 66984 Cataract extraction with IOL and the surgeon sees the patient for the first 10 days?