Reader Question: 68761 With E/M? Check Documentation First (November 2011)
Question: When my ophthalmologist does a comprehensive exam (92004) and decides to insert punctal plugs on the same day, do I need the 25 modifier on the exam?Texas SubscriberAnswer: If you plan to report 92004 (Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient …) separately, then yes, you would need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the [...]
Reader Question: Specify Refraction Exclusion to Clarify ABN Confusion (November 2011)
Question: Are patients undergoing keratoconus workup or contact lens fitting still required to sign an advance beneficiary notice (ABN)? Why is it necessary when Medicare won’t pay for it anyway?Nebraska SubscriberAnswer: According to CMS, the ABN is necessary “for the physician to bill a Medicare beneficiary for services which are always denied for medical necessity (e.g., visual fields for a patient without a covered diagnosis), frequency limited items (repeat of visual fields or other test [...]
YAG Procedures: 66821 Essentials: Break YAG Capsulotomies From Cataract Globals (October 2011)
Heed these documentation and modifier tips to ethically earn an extra $160 for after-cataract services. Ophthalmologists perform thousands of cataract surgeries each year, which can lead to a fair share of post-op complications that can be difficult to code. Fair reimbursement for postoperative procedures for complications – such as after-cataracts – depends on the direction that follows on airtight documentation and skillful modifier use. Beware PCO Within Global The problem: Posterior capsule opacification (PCO), also known as [...]
Once ICD-10 is implemented in 2013, the diagnosis codes in the above story will be different. Check out this crosswalk for the correct after-cataract diagnoses:
Follow this strategy and earn $67 for each contact lens procedure.You know you can’t bill Medicare for regular refractive contact lenses, but you can expect reimbursement for contact lenses for patients presenting with keratoconus and aphakia – if you know these expert rules of the road.Prove Medical Necessity for Keratoconus PatientsSituation: A 16-year-old patient presents with distorted and blurred vision along with glare and light sensitivity. The ophthalmologist diagnoses keratoconus (371.60-371.62) and fits special contact lenses [...]
Plus: E-prescribing hardship exemptions are due in November, CMS reminds.Ophthalmology practices from all across the country are wondering what they should do if their vendors aren’t ready for 5010 conversion before the deadline of Jan. 1, 2012. CMS chimed in with tips on how to handle these issues during the agency’s Sept. 20 Open Door Forum, and we’ve got the advice for you.The message: If you want to avoid a cash flow crisis, talk to [...]
You Be the Coder: Vitreous Strands (October 2011)
Question: Our ophthalmologist has performed a YAG laser for a diagnosis of “vitreous strands.” I don’t see that listed as an acceptable diagnosis for 66821, however. Is there an appropriate ICD-9 code?Ohio SubscriberAnswer: The ICD-9 code (379.25, Vitreous membranes and strands) is not the problem here – it’s the CPT® code. In this case, you should report 67031 (Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery [one or more stages]), even though [...]
Reader Question: 67912 Covers Gold Lid Weight Insertion (October 2011)
Question: How would I code for insertion of gold eyelid weights to correct lagophthalmos? Is there a code for the supply of the gold weights themselves?Wisconsin SubscriberAnswer: Report CPT® code 67912 (Correction of lagophthalmos, with implantation of upper eyelid lid load [e.g., gold weight]) for the insertion of the gold eyelid weights. Ophthalmologists sometimes weigh down a patient’s upper eyelids to correct lagophthalmos, which is the inability to close the eye completely. Untreated, the condition [...]
Reader Question: 99214: Give Credit for Time Spent With Patient (October 2011)
Question: Our ophthalmologist spends a lot of time discussing treatment options, imaging results, and other issues with patients. How should she document this to support coding E/M based on time?Arizona SubscriberAnswer: When counseling and/or coordination of care take up more than 50 percent of the encounter, and you choose to code based on time, CPT®’s E/M guidelines tell you “the extent of counseling and/or coordination of care must be documented in the medical record.” Medicare’s [...]
Reader Question: Can Provider Change Tax ID? (October 2011)
Question: One of our physicians wants to stop billing under the group’s tax ID and start billing under his own tax ID. I’m concerned that doing so will confuse the insurance companies and slow down his income, even though he has personally called some to notify them of the change and the effective date. Some payers are now asking for new W9 forms. Is there an easy way to do it?North Dakota SubscriberAnswer: If your [...]
