| Question |
Answer |
| Occasionally, Medicare Part B patients present without a visual complaint, but the exam reveals a medical problem. What is the correct diagnosis code to submit? |
Regardless of final diagnosis, a Medicare Part B patient who presents for an eye examination without complaint must be reported as a routine eye examination. List ICD-9 codes V72.0 Examination of eyes and vision or 367.0 Hypermetropia, though 367.9 Unspecified disorder of refraction and accommodation should be used as the primary diagnosis. The patient will be responsible for payment. Coverage depends on the purpose of the examination rather than the ultimate diagnosis of the patient’s condition(s). Subsequent visits for the new diagnosis will be a covered benefit. |
| What diagnosis code is appropriate for annual diabetic eye exams? |
It is an industry standard to give people with diabetes an annual eye exam to rule out any ophthalmic complications such as diabetic retinopathy. If the patient’s eye exam is normal, it is necessary to code their diabetes as the reason for the eye exam (250.0x). |
| When coding E&M services, what is indicative of a moderate level of risk? |
Minor surgery with identified risk factors, elective major surgery with no identified risk factors or prescription drug management. |
| When I implant a premium lens, is it appropriate to code this as a complex cataract? |
No. It is not one of the qualifying factors or included in payers’ coverage policies for CPT code 66982 Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage. |
| Can we code a complex cataract surgery on patients who have had LASIK? |
No. It still must meet the criteria as defined by CPT or the payers’ coverage policy. |
| Are all punctal procedures payable per puncta? |
No. Only CPT code 68761 Closure of the lacrimal punctum; by plug, each is payable per puncta. All other lacrimal procedures are payable per eye. |
| When the physician removes a suture, can it be billed as a corneal foreign body removal? |
No. Suture removal is part of the global period. If you are not the surgeon or you remove a suture outside the global period, bill the appropriate level of E&M or eye code. |
| Laser suture lysis should be billed as a wound revision code, correct? |
No. Suture removal by laser or other means is part of the global surgical package, or if outside the global period or you were not the surgeon, it’s a component of your exam. |
| Other than appending modifier –GY to a cosmetic claim that the patient is insistent we submit, how can I make sure the claim will be denied? |
Use V50.1 Other plastic surgery for unacceptable cosmetic appearance for the diagnosis. |
| Chalazia are found on the right and left upper lids. What is the correct CPT code to submit? |
CPT code 67805 Excision of chalazion; multiple, different lids. |
| Is it appropriate to bill for a subconjunctival injection of anesthetic used prior to injecting Lucentis? |
Injections to numb skin/tissue are included in the Lucentis injection code 67028 Intravitreal injection. |
| What diagnosis code should be used for removal of silicone oil? |
996.59 Mechanical complication due to other implant and internal device, not elsewhere classified. |