Ophthalmology and Optometry Coding Alert
Report Reconstruction, Not Excision, if Only 1 Code Allowed
A Reader Question in the May 2005 issue, "Include Pterygium Removal in Reconstruction," advises to code only the amniotic membrane transplant (65780, Ocular surface reconstruction; amniotic membrane transplantation) when an ophthalmologist performs both the transplant and pterygium excision (65426, Excision or transposition of pterygium; with graft) together.
But a Reader Question in the June 2005 issue advises reporting only 65426 when the ophthalmologist performs both procedures.
Our experts agree to report only 65780 when you have to choose only one of those two codes.
Why? CPT code 65780 carries 20.96 relative value units in the Medicare Physician Fee Schedule Database. Code 65426 carries 10.42 RVUs. The two codes are bundled together by the National Correct Coding Initiative - NCCI considers 65780 (the "component code") an intrinsic part of 65426 (the "comprehensive code").
However: NCCI has given this bundle a modifier indicator of "1," allowing you to break the bundle and report the two codes together when appropriate by appending a modifier (such as modifier 59, Distinct procedural service).
But "if it is not appropriate to unbundle these two procedure codes, report only 65780," says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates in Clearwater, Fla.
Hidden trap: Don't try to report both codes without modifiers. "Medicare will price the claim using the value for the comprehensive code, 65426," the lower paying of the two codes, says Raequell Duran, president of Practice Solutions in Santa Barbara, Calif.
We apologize for the confusion.
Ophthalmology and Optometry Coding Alert
- Seal Off Leaky Reimbursement for Diabetic Retinopathy Treatments
Key: The right ICD-9 codes and modifiers can bring your practice an extra $900 for [...] - Use 2 Diabetes Codes for Sweet ICD-9 Compliance
This diagnosis coding trick can help you avoid denials
You've found the correct ICD-9 code for [...] - Reporting Multiple Laser Sessions Only Once? Think Again
2 different kinds of treatments mean 2 separately billable procedures Coding focal laser or panretinal photocoagulation [...] - You Be the Coder:
Topography for Post-LASIK Cataracts
Question: A patient who has had LASIK surgery now has cataracts. One of our ophthalmologists [...] - Treat Detached Retina as Unrelated to Cataract Surgery
DRs and dislocated IOLs are dangerous - for coders and patients Last month, we explained [...] - Reader Questions:
Unwrinkle Nursing Facility POS Codes
Question: Our ophthalmologists sometimes go to see patients in nursing homes. What criteria should I [...] - Reader Questions:
Don't Kid Around With Pediatric Consults
Question: We have a pediatric ophthalmologist who has started to see patients for second opinions [...] - Reader Questions:
Sew Up Wound Leak Repair Coding
Question: My ophthalmologist returned to the OR this morning to repair a wound leak following [...] - Reader Questions:
Include Pterygium Removal in Reconstruction
Question: The ophthalmologist performed a pterygium excision with graft, using an amniotic membrane graft. However, [...] - Reader Questions:
Don't Modify Nonconclusive HRT Claim
Question: How should I code for a nonconclusive HRT? One of our patients had one [...] - Reader Questions:
Downcode E/M to Documented Components
Question: When we determine an E/M code, the chart we use to select the level [...] - Reader Questions:
Report 2nd Doctor's Post-Op Care With -78
Question: If Ophthalmologist 2 in our group practice provides post-op care for a patient whom [...] - Clarification:
Report Reconstruction, Not Excision, if Only 1 Code Allowed
Two articles in recent issues of Ophthalmology Coding Alert give conflicting advice on reporting pterygium [...] - Clarification:
Report Reconstruction, Not Excision, if Only 1 Code Allowed
Two articles in recent issues of Ophthalmology Coding Alert give conflicting advice on reporting pterygium [...]
