• Coding Top 10: Usage of miLoop in Cataract Surgery, CPT Code for Swabbing Cornea and Complex Retina Repair without Membrane Peel


    Coding Top 10, August 2019

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    Get trusted answers to your coding questions from the Academy’s coding experts, so you can bill and code with confidence. The August coding selections include:

    1. Usage of miLoop in Cataract Surgery
      Does use of miLoop qualify cataract surgery as complex?

    2. CPT Code for Swabbing Cornea
      Our physician frequently swabs an area of the eye and sends the sample to be cultured. The closest CPT code I see is 65430 Scraping of cornea, diagnostic, for smear and/or culture. However, it is not scraping, so I am unsure if we should submit.

    3. Unrelated Exam Same Day as Planned Surgery
      Our patient, who was scheduled to come today for a YAG capulotomy in the right eye, came in with a complaint of blurriness and flashes in the left eye. We did an exam of the left eye and performed the YAG in the right eye. How should we submit?

    4. Complex Retina Repair Without Membrane Peel
      Our surgeon performed a complex retinal detachment repair for a patient with proliferative vitreoretinopathy. The surgery included removal and replacement of silicone oil, scleral buckle, IOL repositioning and a laser. However, no membrane peel took place. Can we still submit CPT code 67113 Repair of complex retinal detachment (e.g., proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 degrees), with vitrectomy and membrane peeling, including, when performed, air, gas, or silicone oil tamponade, cryotherapy, endolaser photocoagulation, drainage of subretinal fluid, scleral buckling and/or removal of lens?

    5. Billing Demodex
      We recently acquired a microscope so I could look for a parasite (demodex) in patients’ lashes. Is this billable as a culture?

    6. Did She Keep Oxervate Question? If Yes, Then Make Title Oxervate Training
      When prescribed Oxervate for neurotrophic keratitis, the patient is required to return for training and care of vials. Can we bill insurance for the training, which is performed by the technician, if we have an order?

    7. Modifiers on Drug Codes
      We hired a new billing manager who insists that eye modifiers should be included on the drug codes for intravitreal injections. We’ve never received rejections before. Is this correct billing?

    8. Units for CPT code 67882
      Our surgeon performed CPT code 67882 Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; with transposition of tarsal plate on a patient’s right eye. However, this was performed both on medial and lateral eyelid. Is there another CPT code we should bill?

    9. IOL Master Performed After Ascan Billed
      We performed CPT code 76519 A-scan bilaterally on our patient and billed the first eye.  The surgeon is now requesting CPT code 92136 IOL Master for the second eye. Can we bill this?

    10. Bilateral Punctal Plug Denial
      I performed bilateral punctal plugs and submitted to Novitas Medicare CPT code 68761 with modifier -50 and 1 unit. I received a denial due to an incorrect modifier. Is there another modifier that should be used?