As a young physician, you want to bill correctly the first time. One key to doing so: knowing where to turn when you need reliable answers. At aao.org/coding, the Academy offers many different resources for physicians and staff who need answers now. Test your own coding competency with the five recent submissions below.
1. The ophthalmologist removed a mature pediatric cataract that required the use of trypan blue. This surgery involved an anterior approach using the vitrector rather than pars plana capsulotomy. During the procedure, the physician did not insert an IOL because it was not indicated. What’s the best CPT code?
Answer: CPT code 66982 Complex cataract surgery would not be appropriate, because the physician did not implant a lens.
2. Our administrator told us to bill a sample medication as $0.01 along with the injection. Shouldn’t the charge be zero since we used a sample?
Answer: When billing for an injection that includes a sample medication, you still need to include the drug so the payer is informed.
3. When we order prescriptions for patients, the pharmacy often states that a certain prescription is for a noncovered medication and asks us to provide an alternative. This takes time to research. Can we submit a charge for this research?
Answer: No, this is considered part of the practice expense.
4. We have a new physician joining our practice. She will join sooner than her license is available and prior to credentialing. Can we bill under the group with a specific modifier? Are locum tenens modifiers -Q5 and -Q6 an option?
Answer: Hiring a new physician does not qualify you for locum tenens.
5. I’ve read that if we perform a test that is inherently bilateral on one eye, we need to append modifier -52 Reduced services. However, the Academy states that we should not append. Can you clarify?
Answer: Here’s why we say not to append modifier -52.
In-Depth Guidance on Billing New Procedures
In addition to routine answers like those above, the Academy’s coding experts also provide more in-depth guidance in a monthly EyeNet column and occasional guides like the following.
- Sign up to attend the nearest, in-person Codequest course.
- Send your own questions to email@example.com.
- Check out all of the other coding resources the Academy offers at the Academy Store.
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About the authors: Jenny Edgar, CPC, CPCO, OCS, is the Academy’s coding specialist. She is also a contributing author to the Ophthalmic Coding Coach and Ophthalmic Coding series. Sue Vicchrilli, COT, OCS, is the Academy’s director of coding and reimbursement and the author of EyeNet’s “Savvy Coder” column and AAOE’s Practice Management Express, Ophthalmic Coding Coach and Ophthalmic Coding series.