Avoid Fines: Do Not Code Separately for Schirmer Tests   (July 2000)

Many ophthalmologists wonder if they can bill separately for the Schirmer test, which measures tear production. Some ophthalmologists bill for it with 95060 (ophthalmic mucous membrane tests). According to coding experts, this is wrong and could lead to fines.That is a big no, says Heather Freeland, consultant with Rose and Associates, a compliance, reimbursement, and coding consulting firm specializing in ophthalmology and based in Duncanville, Texas. They cant use 95060 unless they are testing the [...]

You Be the Coder: Vitrectomy   (July 2000)

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.Question: What is the correct way to code 67038 (vitrectomy, mechanical, pars plana approach; with epiretinal membrane stripping) and 66852 (removal of lens material; pars plana approach, with or without vitrectomy) together?Texas Subscriber

Answer: Though it would seem that the two codes would be considered a bundle (two services that cannot be billed together on the [...]

Reader Question: Corneal Graft   (July 2000)

Question: We have a post-corneal-graft patient and we need to do topographical mapping in order to fit a contact lens properly. The code we use for this procedure is 92499 (unlisted ophthalmological service or procedure). However, not all insurance companies will pay separately for this procedure. The question is: should we charge the patient for corneal mapping, or can we bundle it with either a 99215 or a 92310 (prescription of optical and physical characteristics [...]

Reader Question: A-scan   (July 2000)

Question: What level of physician supervision is now required by HCFA for an A-scan (76519)? Level-one, level-two, or level-three? Vermont SubscriberAnswer: The final rule for the 1998 Physician Fee Schedule and Payment Policies for the Medicare Program were published in the Oct. 31, 1997, Federal Register. Note: Although most of the final rule was implemented on Jan. 1, 1998, HCFA postponed implementation of the language relating to the supervision of testing services.In a memorandum to [...]

Reader Question: Repair of Canalicular Laceration   (July 2000)

Question: I am looking for a CPT code for plastic repair of canalicular laceration requiring silicone tubes. Delaware SubscriberAnswer: There is only one code listed for repair of canalicular repair, which is 68700 (plastic repair of canaliculi). The code that includes in its description with insertion of tube or stent is for 68750 (conjunctivorhinostomy [fistulization of conjunctiva to nasal cavity); with insertion of tube or stent). Unless the ophthalmologist actually performed the more extensive procedure, [...]

Reader Question: Specialty Contact Lens Fit   (July 2000)

Question: Is there a code for a non-medical specialty contact lens fit (i.e., bifocals)?Nevada SubscriberAnswer: There are two codes, 92310 (prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia) and 92313 (prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneoscleral lens) to report contact lens fitting for a phakic patient. Phakic [...]

Reader Question: Severing Adhesions   (July 2000)

Question: Is there a limited coverage diagnosis table for procedure code 65865?Texas SubscriberAnswer: Code 65865 (severing adhesions of anterior segment of eye, incisional technique [with or without injection of air or liquid] [separate procedure], goniosynechiae), should be paid by Medicare and other payers based on the diagnosis submitted that supports the medical necessity for performing the procedure. Although there is not a national list of covered diagnosis codes for the procedure, most carriers do have [...]

Reader Question: YAG Capsulotomy   (July 2000)

Question: We have performed some clear lens extractions, which is an elective surgery, and have since had to perform some YAGs on these patients which is typically a covered service. How do we bill for this knowing that there will not be a cataract date to match the YAG to? Will the YAG be a covered charge? Also, we have performed some specular microscopy procedures in preparation for some LASIK procedures. [...]

Avoid Fraud: Fundus Photography and Fluorescein Angiography Need Two Separate Reports   (June 2000)

Many ophthalmologists feel its necessary to perform 92250 (fundus photography with interpretation and report) and 92235 (fluorescein angiography [includes multiframe imaging] with interpretation and report) together. As the descriptors indicate, both codes include an interpretation and report. But some ophthalmologists are asking, if these two procedures are done in connection, why they have to do an interpretation and report of 92250 if they have one for 92235 already in the chart. The short answer is: [...]

Coding News: Modifier -25 May be Required With Procedures That Have No Global Periods   (June 2000)

Ophthalmologists should be on alert for another possible change to modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Already there is a change in CPT 2000 modifier -25 must be used with the office visit when a starred procedure (minor surgery such as epilation) is performed. Now a proposal is on the table to require the use of modifier [...]