Ophthalmology and Optometry Coding Alert

Tip: Stress the importance of medical necessity in the documentation to your ophthalmologist.When the ophthalmologist decides to place punctal plugs, choosing the procedure code seems easy because you only have one code to choose from. But if you don't apply the correct modifiers or provide medical necessity in the physician's documentation, you can kiss your reimbursement goodbye. Follow these three simple steps to guarantee you'll see payment on each plug placement procedure.1. Don't Change Procedure Code Based on Plug TypeThere are three types of punctal plugs that your ophthalmologist may use: temporary collagen, semipermanent silicone, and intra-canalicular plugs. How you code the plug placement doesn't change based on the type of plug.You should use 68761 (Closure of the lacrimal punctum; by plug, each) for punctal plug insertion, regardless of type. There is no code for removal of plugs, notes David Gibson, OD, FAAO, a practicing optometrist in Lubbock, Texas.Tip: Carriers [...]