Tag Archives: ophthalmology
Ophthalmology Coding Challenge: Flashers & Floaters
Posted on 24. Jan, 2010 by Editor.
How’s Your EO Coding & Billing? Test Yourself With This Scenario.
Question: A patient reports flashes and floaters but the ophthalmologist does not find evidence of retinal pathology on routine ophthalmoscopy. Are we justified in billing for extended ophthalmoscopy (EO)?
Answer: If the ophthalmoscopy is a routine part of a patient’s eye exam, do not bill for it separately. However, complaints of flashers and floaters are always serious and must be evaluated carefully; often, these symptoms will justify extended ophthalmoscopy (92225, Ophthalmoscopy, extended, with retinal drawing [e.g., for retinal detachment, melanoma], with interpretation and report; initial).
Use 92225 to report a Goldmann-3 exam (examining the retina with a three-mirror goniolens). Remember to keep your interpretation and report of the findings in the patient’s medical record. In many cases in which flashers and floaters are present, extended ophthalmoscopy (EO) combined with a retinal exam shows vitreous degeneration or posterior vitreous detachment (379.21, Vitreous degeneration). If an ophthalmologist does not see anything in the routine ophthalmoscopy, he will probably not do an EO.
In the unlikely event that the ophthalmologist doesn’t find any significant problems with the retina after the EO, link 92225 to 379.24 (Disorders of vitreous body; other vitreous opacities). “Vitreous floaters” appears in a note under that code in the ICD-9 manual. If the ophthalmologist does not see floaters, look to the 368.1x series (Subjective visual disturbances).
However: If the ophthalmologist can’t see anything more with an EO than he can see with a routine ophthalmoscopy, defending the use of the EO may be difficult. Some experts recommend not billing for an EO unless there is some abnormality of the retina or vitreous to draw in the report.
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Cataract Surgery Coding Skill Builder
Posted on 19. Jan, 2010 by sanjay.aikat.
Determine ‘planned or unplanned’ before separately coding vitrectomy.
With several possible surgical treatments for cataract procedures, which you probably code more often than any other surgery, there’s a lot of room for error – with over $890 at stake for complex cataract procedures in 2009.
Use these tricky scenarios as a guide through some of the most problematic cataract coding situations:
Document Necessity for Planned Vitrectomy
Scenario: During the course of a cataract removal, the vitreous collapses and the ophthalmologist finds it necessary to perform a vitrectomy.
Problem: Can you code separately for the vitrectomy?
Read more to learn solution …
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Eye Surgery Coding Challenge: Denials for 15823 & 67904
Posted on 04. Nov, 2009 by Editor.
Question: I started receiving denials for 15823 and 67904. To report this combo, should I use a modifier?
Answer: If the ophthalmologist performs the blepharoplasty (bleph) with excessive weight (15823, Blepharoplasty, upper eyelid; with excessive skin weighting down lid) on one eye and the blepharoptosis (ptosis) repair (67904, Repair of blepharoptosis; [tarso] levator resection or advancement, external approach) on the other eye, you may be able to report both codes by using modifier 59 (Distinct procedural service) on 15823 to designate a separate site from 67904. Otherwise, you should report only 67904.
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Ophthalmology Coding: GDX, VF, & Temp Plugs — How Many Modifiers?
Posted on 01. Nov, 2009 by Editor.
Question: A patient came in for a GDX and visual field (VF) tests. During the same visit, the ophthalmologist put in temporary plugs. Can we get paid for all services on the same day? I know the office visit needs a modifier. Do I need to put one on the GDX & VF, too?
Answer: Provided the ophthalmologist made the decision to perform the tests during this visit, you may bill for the office visit and the testing. You should be able to get paid for all services using four modifiers — one on the office visit as you indicated, one on each plug code, and one on the GDX. You do not need a modifier on the VF (92081-92083, Visual field examination, unilateral or bilateral, with interpretation and report …).
Warning: If the patient was scheduled to come in for the GDX and VF testing as the result of a previous office visit, you should bill only the GDX and VF testing.
Unless there is a need for the physician to perform another office visit evaluation (worsening symptoms, new symptoms), do not report the office visit. Inserting a plug (68761, Closure of the lacrimal punctum; by plug, each) is a minor procedure that includes related evaluation and management work. You should only report an E/M when documentation supports the service as significant and separately identifiable from the plug insertion. In these cases, you need modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the office visit (99201-99215, Office or Other Outpatient Services).
Make sure to use separate diagnoses for the problem and for the primary reason or diagnosis for the visit. (Please click ‘read more’ for a money-saving tip and how you should code for an insurer…
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Avoid This Blepharoplasty Coding Blunder
Posted on 29. Mar, 2009 by Editor.
Don’t settle for denials for a functional surgery that a payer incorrectly assumes is cosmetic, warn American Academy of Ophthalmology coders Sue Vicchrilli & Kim Ross.
Code 15823 (Blepharoplasty, upper eyelid; with excessive skin weighing down lid) can describe a medical necessary procedure to correct a visual complaint. However, payers might deny the claim as cosmetic if the documentation doesn’t note that the saggy eyelids are impairing vision, write Vicchrilli and Ross in a recent issue of the AAPC’s Coding Edge.
Watch out if the chart states simply something like “Patient complains of excessive baggy upper lid skin.”
April 2 AUDIO: Master Cataract Co-Management Billing and Coding.
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Keep These 2009 PQRI Eye Care Measures Handy
Posted on 23. Mar, 2009 by Editor.
Ophthalmologists and optometrists who want to recoup a bonus from Medicare can choose to participate in the Physician Quality Reporting Initiative (PQRI) again — this time with a higher rate of return.
The basics: In 2008, the PQRI bonus was 1.5 percent for practices that met the measures. In 2009, PQRI pays a 2 percent bonus.
The first step in PQRI participation is focusing your reporting on measures the optometrist will often meet. According to CMS, the 2009 PQRI includes 153 reporting measures; however, only a handful will be relevant to eye doctors.
In 2009, CMS is retaining five eye care PQRI measures from 2008. Please click here to see the chart.
AUDIO ON-DEMAND: Eye Code or E/M Code? With reimbursement visionary Deb Grider.
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Worksheet: Visual Field Exam Coding & Documentation
Posted on 05. Mar, 2009 by Editor.
If your ophthalmologist isn’t following the extensive documentation requirements for you to code visual field tests, you’re setting yourself up for medical necessity questions and an audit.
ON-DEMAND AUDIO: Eye code or E/M code. Deb Grider shows you how to tell for sure.
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Cataract Removal Eye-Opener: 66984
Posted on 04. Mar, 2009 by Editor.
CPT 66984 is the number-one procedure performed in ASCs, according to an article in the March issue of AAPC’s Coding Edge.
Watch Out: Many physicians and coders think there is a national policy with a visual acuity requirement, but there isn’t. Coverage varies by carrier, and good documentation should indicate what impact the cataract has had on the patient’s daily living activities, authors Sue Vicchrilli & Kim Ross advise.
The 3 most common mistakes coders make with cataract co-management.
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