The American Academy of Ophthalmic Executives has lately received a host of interesting questions inquiring about different coding-related matters. Below is a selection of the standouts. For information about courses, online tools and products related to coding or to contact AAOE staff directly, visit the AAOE’s new website.
| Question |
Answer |
| An established Medicare Part B patient schedules an appointment solely for the purpose of having our physician complete a driver’s license form. Should this be coded as a 99212? |
If completing the form is truly the only reason for the encounter, no claim should be submitted to Medicare Part B (or any other payer). The patient is responsible for payment for the exam and any testing service performed. |
| If YAG capsulotomies are performed on both eyes the same day, is payment 200 or 150 percent? |
Per multiple-surgery guidelines, payment would be at 150 percent. The claim may be submitted as a one-line item 66821–50 or a two-line item using modifiers –RT and –LT. |
| What is the correct way to bill CPT code 92286 Anterior segment imaging with interpretation and report; with specular microscopy and endothelial cell analysis? We have an outside company come into the office to take the photos. Are we to bill for the professional component only with –26 modifiers or no modifier? |
When practices contract with an outside company, the physician should submit the claim as though they own the equipment. Submit CPT code 92286 only. No need to append any modifier to this inherently bilateral service. |
| Is there a CPT code for a clear lens exchange? There is no evidence of a cataract. |
Because the patient is responsible for payment and no claim is submitted to a payer, practices can use an unlisted CPT code or create an internal code to track these surgeries. |
| A patient is in a postop period for cataract surgery in both eyes, and comes in for an intravitreal injection in both eyes. How would this be billed? The patient had an optical coherence tomography (OCT) macula scan in both eyes as well. I know I don't need a modifier on CPT code 92134 SCODI, posterior segment, with interpretation and report, unilateral or bilateral; retina for the OCT, but I’m unsure about what to do with the 67028 Intravitreal injection of a pharmacologic agent (separate procedure) and the J0178 Injection, aflibercept, 1 mg for both eyes. |
The bilateral injection may be submitted either as a one-line item, 67028–58–50, or as two lines using modifiers –58–RT and –58–LT.
J0178 may be submitted as a one-line item with modifier –50 or two lines appending modifiers –RT and –LT. Make sure the correct number of units is submitted. Healthcare Common Procedure Coding System injection codes do not require modifier –58.
Because the macula OCT is inherently bilateral, it would only be submitted once. |
| Patients can be charged an out-of-pocket expense for presbyopic and toric IOLs. What about monovision lenses? |
CMS or any other payer has not provided a method for this. It is inappropriate to have the patient sign an Advance Beneficiary Notice of Noncoverage and bill out-of-pocket for monovision. |
| Can we sell postop kits from our office? They include a prescription drug. |
Yes, postop kits may be sold. Two issues to consider:
1. Are there sales tax issues in your state? If yes, you’ll need to charge tax and file a quarterly tax report.
2. Are there state laws regulating the sale of prescription drugs? Many practices sell the kit but give the patient the prescription drug at no charge. |
* * *
About the author: Sue Vicchrilli, COT, OCS, is the Academy’s coding executive and the author of EyeNet’s “Savvy Coder” column and AAOE's Coding Bulletin, Ophthalmic Coding Coach and the Ophthalmic Coding series.