Reader Question: Condition Doesn’t Change Patient Status   (October 2011)

Question: Our office saw a patient six months ago for a certain condition, and sent the patient back to his primary care provider for further treatment. The same patient was recently referred back to us for a different condition. Should we bill that patient as new, since he’s coming back for a different reason?
New Mexico SubscriberAnswer: This patient should be considered “established” for many reasons. If your physician sees a patient any time within a 36-month [...]

Strabismus: 67311-67318 Success Depends on Detailed Anatomy Understanding   (September 2011)

How many muscles? Horizontal or vertical? The answers will keep your coding from getting crossed up. When an ophthalmologist performs strabismus surgery, it can involve any combination of 12 extraocular muscles. Incorrectly identifying just one of those muscles can lead you to the wrong code – and take more than $700 in reimbursement out of your practice’s pocket. But you don’t need a PhD in anatomy to keep the eye muscles straight – all you need are [...]

ICD-10 Readiness: Start Small When Prepping for ICD-10 Conversion, CMS Says   (September 2011)

Acquaint yourself with the top 30 diagnoses that your practice sees and you’ll get a head start toward compliance.If you’ve taken a look at the ICD-10 book, you know that it would be virtually impossible to memorize all of the codes that it contains. But preparing for ICD-10 won’t require you to even try to know the codes by heart, CMS reps indicated during the August 3 CMS call, “ICD-10 Implementation Strategies for Physicians.”Take heart: [...]

ABN: You Must Use New Form by Nov. 1, CMS Says   (September 2011)

Don’t expect major changes, but you are required to switch.You should be used to the combined Advance Beneficiary Notification (ABN)/ Notice of Exclusion of Medicare Benefits (NEMB) form implemented last year. But did you know it’s time again to upgrade to a newer version?The latest version of the ABN —  form CMS-R-193, with the release date of March 20, 2011– is now available at www.cms.gov/BNI by clicking the “revised ABN” link, said CMS’s Donna Williamson [...]

You Be the Coder: Silicon Oil Removal   (September 2011)

Question:  Our ophthalmologist examined a patient who had recently had retinal repair and had silicon oil inserted in the vitreous cavity. The ophthalmologist found elevated pressure in the patient’s eye and removed the silicon oil to correct the problem. I can’t find a code for the silicon oil removal.Illinois SubscriberAnswer: If your ophthalmologist removed the silicon oil by performing a vitrectomy, which is how it’s typically done, report code 67036 (Vitrectomy, mechanical, pars plana approach). [...]

Reader Question: 92235 Should Bring Full Pay Per Eye   (September 2011)

Question: Can I report 92235 times two, bilateral eyes for each visit when the ophthalmologist photographs both eyes?California SubscriberAnswer: You can report 92235 (Fluorescein angiography [includes multiframe imaging] with interpretation and report) per eye and code it twice when your ophthalmologist performs the test on both eyes. Depending on your carrier’s preference, you should append modifier 50 (Bilateral procedure) or modifiers LT (Left side) and RT (Right side) to 92235 when billing bilaterally.You can confirm that [...]

Reader Question: 66170 Includes Trabeculectomy Suture Removal   (September 2011)

Question: I am trying to bill for the removal of sutures the ophthalmologist placed during a trabeculectomy. My initial billing was a 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 SubscriberAnswer: Sometimes, during a trabeculectomy, an ophthalmologist places a suture with the intention of cutting it during the postoperative period if the flow of fluid out of the eye is [...]

Reader Question: 99241-99245 Requires You to Distinguish Consultation, Transfer of Care   (September 2011)

Question: We commonly see patients referred by another physician. Our ophthalmologist performs an office exam that frequently results in a later procedure. Should we code these as consultations or transfer of care? Do we need a written notice from the referring physician for consultations?Texas SubscriberAnswer: Consultations are requests from an appropriate provider for advice, opinion, or recommendations on treatment. This can be for a known or unknown problem. Therefore, if a provider is sending patients [...]

Reader Question: 99058 May Help You Collect Extra for Emergency Walk-Ins   (September 2011)

Question: We recently hired a new podiatrist who is questioning whether we can bill any extra codes for a walk-in established patient. He told us that his previous practice was able to collect for the office visit code and 99058. Is this accurate?West Virginia SubscriberAnswer: Many practices do collect for 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service) when billed with office visits, but [...]

Reader Question: Know When to Bill Secondary Payer   (September 2011)

Question: We have many patients with secondary insurance, some of which have deductibles on the secondary. In these cases, should we write off the amount of the deductible because it’s secondary, or do we bill the patient?Virginia SubscriberAnswer: Most practices do bill the secondary insurance on behalf of patients, but if the patient has a deductible on the secondary insurance, you can and should bill the patient that amount.You can find out about secondary insurers by [...]