Diagnostics: Read This Before Your Next Extended Ophthalmoscopy Claim   (July 2010)

Ensure you know what qualifies as an EO, and go beyond routine coding.
Most eye exams include some form of ophthalmoscopy, but payers often bundle this service into the general ophthalmic exam, or E/M codes So how do you know when the exam warrants an extended ophthalmoscopy (EO) code? You’ll have to provide more detailed documentation and drawings to prove medical necessity and support code assignment for the more complicated service.
Read on to make sure you’re [...]

Reader Questions: Report TC for VFs Ordered by Outside Doctor   (July 2010)

Question: We performed a visual field ordered by a doctor outside our practice. The patient is not being seen by any doctor in the practice, and the visual field is being sent back to the ordering doctor for interpretation. How should I code for that?
West Virginia Subscriber
Answer: Report only the technical component of the visual field test, 92081 (Visual field examination, unilateral or bilateral, with interpretation and report; limited examination … ), 92082 ( … [...]

Reader Questions: Shun 67312 in This Strabismus Scenario   (July 2010)

Question: My ophthalmologist removed a 6.5-mm section of the lateral rectus muscle of a patient’s left eye and resected the muscle to strengthen it and correct strabismus. He then repeated the procedure on the right eye, again removing 6.5 mm of the lateral rectus muscle and then resecting it. Is 67312 the correct code to report because the ophthalmologist performed a resection procedure on two horizontal muscles?
Georgia Subscriber
Answer: You should not report code 67312 [...]

Reader Questions: Include Both Days’ Work for Delayed Dilated Exam   (July 2010)

Question: How should we handle it when a patient who has come in for a regular eye exam insists on coming back at a more convenient time to have his eyes dilated for the glaucoma check? Should I code this as one visit after the patient comes back or are they considered two separate visits?
Maryland Subscriber
Answer: If the patient returns for a dilated follow-up (also known as a dilated fundus examination or DFE), report the ophthalmologist’s [...]

Reader Questions: Find ‘Track or Treat’ Evidence for 92285 Claims   (July 2010)

Question: Our ophthalmologist performs external ocular photography for a Medicare patient with a malignancy on her left eyeball. Is this a covered service?
New York Subscriber
Answer: Based on the patient’s diagnosis (190.0, Malignant neoplasm of eyeball, except conjunctiva, cornea, retina, and choroid), the photography should be covered – if your ophthalmologist is taking the photos in an effort to “track or treat” the malignancy.
Medicare will typically cover 92285 (External ocular photography with interpretation and report for documentation [...]

Reader Questions: Code Blepharoplasty First in ASC   (July 2010)

Question: Our oculoplastic surgeon performed levator resection and blepharoplasty on both upper eyelids in the same surgical session. Can I code these procedures together (15823 and 67904), or are they considered bundled? Which one should I code as the primary procedure?
Indiana Subscriber
Answer: The codes – 15823 (Blepharoplasty, upper eyelid; with excessive skin weighting down lid) and 67904 (Repair of blepharoptosis; [tarso] levator resection or advancement, external approach) – are not bundled, so you can report them together.
Remember [...]

Reader Questions: Focus on 66985 for Secondary Implant   (July 2010)

Question: A patient is going to have a secondary IOL implant. Is 66985 the right code? What’s the difference between 66985 and 66986?
Tennessee Subscriber
Answer: If the ophthalmologist is inserting an IOL implant in a patient who had cataract surgery previously but did not have a lens implanted at the time of the previous surgery, report 66985 (Insertion of intraocular lens prosthesis [secondary implant], not associated with concurrent cataract removal). For example, if complications during [...]

Reader Questions: Make Sure Your EHR Passes PQRI Muster   (July 2010)

Question: We have been participating in the physician quality reporting initiative (PQRI), and I heard that you could report a measure if your practice is implementing electronic health records (EHR). We started making the transition from paper to digital record-keeping in January 2010; is there an EHR measure in the PQRI pantheon?
Missouri Subscriber
Answer: There is a measure that you can report for using EHR: Measure 124 (Health Information Technology: Adoption/ Use of Electronic Health Records [...]

You Be the Coder: Trabeculectomy Revision   (July 2010)

Question: I am trying to bill a revision for a trabeculectomy. I coded the initial procedure as 66170. What code and what modifier should I use? The revision is taking place within 30 days of the initial surgery by the same physician.
Florida Subscriber
Answer: The answer depends on whether your ophthalmologist performed the revision in the office or required a return to the operating room (OR). For revision procedures provided in the office, Medicare considers [...]

Punctal Plugs: Follow 3 Steps for Prompt Punctal Plug Payment   (July 2010)

Tip: Stress the importance of medical necessity in the documentation to your ophthalmologist.
When the ophthalmologist decides to place punctal plugs, choosing the procedure code seems easy because you only have one code to choose from. But if you don’t apply the correct modifiers or provide medical necessity in the physician’s documentation, you can kiss your reimbursement goodbye. Follow these three simple steps to guarantee you’ll see payment on each plug placement procedure.
1. Don’t Change Procedure [...]