You Be the Coder: Graft Revision (January 2012)
Question: After a pterygium removal, the patient’s conjunctival allograft dislocated. The ophthalmologist repositioned and sutured the conjunctival graft. Should I use 66250? Do I need a post-op modifier?Florida SubscriberAnswer: Yes, CPT® code 66250 (Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure) describes the repair the ophthalmologist performed. If the service occurs at the same surgical session as the pterygium removal, you won’t need a modifier, [...]
Reader Question: List Referring Doctor’s Name for Pachymetry (January 2012)
Question: I am billing pachymetry (76514, 1 unit) with a diagnosis code of 365.04 (Ocular hypertension). However, Medicare is denying my claim saying, “Claim lacks information which is needed for adjudication. Additional information is supplied using the remittance advice remarks codes whenever appropriate.” How can I correct this problem?California SubscriberAnswer: Make sure you have the referring doctor’s name (”Name of Referring Physician or Other Source”) and 17a (”I.D. Number of Referring Physician”) of your CMS form – [...]
Reader Question: 66985 Focuses on Secondary Implant (January 2012)
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 SubscriberAnswer: 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 the [...]
Reader Question: Base Billing Order on RVU Order (January 2012)
Question: I know that as a general rule the highest RVU has a higher billed amount and that when you bill you should always put the highest amount first. But when it comes to bilateral surgeries is it true that you would sometimes be prudent to put another procedure first because a bilateral code that was done bilateral/unilateral would still be paid at a reduced allowable?Texas SubscriberAnswer: Yes, you should sometimes put another procedure first. If [...]
Once ICD-10 is implemented in 2013, the diagnosis codes in the above story will be different. Check out this crosswalk for the correct foreign body diagnoses:Useful tool: Prepare for ICD-10 with SuperCoder’s ICD-10 Bridge, available exclusively on www.SuperCoder.com.
CPT® 2012 Update: 92070 For Therapeutic Contacts? Not Anymore (December 2011)
New codes 92071 and 92072 carry the load for lens prescriptions for keratoconus and OSD . Although you can’t bill Medicare for regular refractive lenses, savvy ophthalmology coders know that you can expect reimbursement for contact lens prescriptions to treat keratoconus (ICD-9 codes 371.60-371.62) and ocular surface disorders (OSDs) like corneal abrasions and dry eye. However, what coders currently know is changing in 2012, with the deletion of one familiar CPT® code and the introduction [...]
Once ICD-10 is implemented in 2013, the diagnosis codes in the above story will be different. Check out this crosswalk for the correct keratoconus diagnoses:
Plus: Avoid PO boxes on 5010, despite what your MAC tells you.Sweating over the fact that your 5010 standard won’t be in place by the Jan. 1 deadline? CMS has an early holiday gift for your ophthalmology practice, with the Nov. 17 announcement that it will not initiate enforcement action regarding 5010 until March 31, 2012.Not a deadline shift: CMS stresses in its statement that the 5010 compliance date remains Jan. 1, 2012. However, the [...]
Medical Necessity: 3 Steps Focus Diagnosis Coding for Your Eye Surgery Claims (December 2011)
Add these tips to your ICD-9 toolbox.You won’t get paid for your ophthalmic surgeon’s work if you only focus on what he did; you also need to focus on why he did it. Choosing the right ICD-9 code tells the “why” story – and that’s the basis for demonstrating medical necessity for the procedure.Follow our experts’ tips to make sure you pick the right ICD-9 code to reflect your surgeon’s diagnosis documentation, and to make sure [...]
E/M: HPI Know-How Helps You Catch Level 4 and 5 E/M Opportunities (December 2011)
Beware of CPT® and Medicare differences when counting HPI elements.Not accurately accounting for the history of present illness (HPI) documented by your ophthalmologist could result in missing appropriate opportunities to report level 4 or 5 E/M visits. Ensure you’re not missing higher paying possibilities by reviewing this guide to capturing HPI elements.Brush Up on What Qualifies as an HPI ElementHPI is one of the three elements comprising an E/M history. It describes the patient’s present [...]
