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Insertion of Punctum Plugs

Atlantic Posted Mon 17th of January, 2011 14:42:05 PM

Provider is doing probing of nasolacrimal duct with irrigation and insertion of Punctum Plugs. What is the proper CPT coding for the procedure and the Punctum Plugs in 2011. The punctum plugs are expensive, can we charge separately for them and only bill the insurance for the actual procedure?

SuperCoder Answered Tue 18th of January, 2011 13:54:40 PM

Generally, for insertion of punctum plugs, the physician probes the nasolacrimal duct. So in this case, probing is an integral part of insertion of the plug and you cannot report these two codes together. The only code that can be billed is 68761 twice for 1 eye and four times for both eyes.
Remember: Medicare will reimburse for two plugs per beneficiary or two permanent closures per beneficiary on any given day. Up to two additional plugs or two additional closures may be performed for a total of four, but documentation must clearly show that the two additional plugs or closures were medically necessary as additional treatment to alleviate the condition.

Atlantic Posted Tue 18th of January, 2011 14:41:10 PM

So 68761 did not change in 2011? That is the code I am currently utilizing.
My question is: Are the punctum plugs billable separately with A4262/A4263?

SuperCoder Answered Wed 19th of January, 2011 06:34:45 AM

Yes you can bill the HCPCS code A4262/63 along with these insertion code (68761).

Pessie Answered Thu 20th of January, 2011 14:11:03 PM

No listed fee for Punctum Plugs? A4262/63?

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