Recently, the American Academy of Ophthalmic Executives has received a number of interesting questions regarding coding-related matters. Below are the highlights.
1. An ophthalmologist removed both the medial and lateral pterygia with mitomycin and applied an amniograft on the same eye. Are we allowed to bill two units since the surgeon removed two different ptergyia?
You can attempt to submit by appending modifier –59, indicating separate procedure, or –XS, indicating a separate site from Medicare Part B on the second procedure code. Additional information always helps, so be sure to provide a narrative note in box 19, noting both nasal and temporal removal on the same eye. You may have to appeal. Some payers may decide to cover the second site, but some may not.
2. A cataract surgeon works at my practice part time. Will they need to perform Physician Quality Reporting System measures at my practice if they are reporting the Cataract Measures Group in their main practice?
Yes. According to the Medicare Quality Helpdesk, the physician needs to report measures for each location where he or she practices.
3. If we remove punctal plugs within the 10-day global period, can we bill an office visit? They are being removed due to patient discomfort. The payer is Medicare Part B.
There is no code for removal of punctal plugs. During the postoperative period, there would be no charge. If they were removed outside of the global period, submit the appropriate level of office visit.
4. Are corneal filaments considered a foreign body removal? Would the removal be billable with an unlisted code separate from the exam on an established patient?
You cannot bill the removal separately from the exam. Typically, filaments are viewed as something that can almost be wiped out of the eye with a cotton swab. CPT code 65222 implies that the foreign body is usually a material such as wood or metal, not something the body produces. Filament removal would not be appropriate for this code.
5. Our physician plans to remove a Crawford nasolacrimal duct tube from a 2-year-old girl under general anesthesia. The only code I can find is 68530. Is this correct?
The appropriate code is CPT 92019 Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; limited. CPT code 68530 Removal of foreign body or dacryolith, lacrimal passages was not intended for this use. Keep in mind that ASCs do not have an allowable for 92019.
6. How often do we need to have patients fill out new paperwork for the review of systems and the past family and social history?
Although you may review and update both the past family social history and review of systems at each visit, you should get new paperwork if the rules change or when you haven’t seen the patient for more than three years and one day (1,096 days). In that case, the encounter is considered a new patient exam again.
7. Does modifier –51 still need to be appended to multiple procedures when submitting a claim?
Many payers no longer require modifier –51. Computer systems are programmed to hard code the modifier and automatically reduce payment on claims with multiple surgical procedures.
8. Can I still bill for CPT code 67255 Scleral reinforcement; with graft when submitting CPT code 66180 Aqueous shunt to extraocular equatorial plate reservoir; external approach; with graft?
No. These two codes are now bundled due to the new language associated with CPT code 66180.
9. Our physician will be using a femtosecond laser for cataract surgery and will also be performing an astigmatic keratotomy. Can I bill for the radial keratotomy to correct the astigmatism since we are using this laser?
CPT 65771 Radial Keratotomy is not an appropriate code. All payers will cover medically necessary cataract surgery but not concurrent correction of astigmatism performed for refractive conditions. You may charge patients a fee for correcting the astigmatism whether using the femtosecond laser or not. Use the unlisted CPT code 66999.
10. Our practice has heard mixed feedback about bilateral injections. Regarding audits, what’s the Academy’s advice when performing these injections the same day?
Due to the high volume of bilateral injections performed in a single day, these services are now on the watch list for Zone Program Integrity Contractors audits. Best practice is to make sure you keep patient consents, documentation of inventory and other records up to date.
Have questions of your own? Send them to email@example.com.
* * *
About the author: 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 Coding Bulletin, Ophthalmic Coding Coach and Ophthalmic Coding series. Jenny Edgar, CPC, CPCO, OCS, is the Academy’s coding specialist. She oversees the Academy’s Chart Auditing Service and is also a contributing author to the Ophthalmic Coding Coach and Ophthalmic Codingseries.