Ophthalmology and Optometry Coding Alert

Question: Regarding punctal plugs (A4263), if we use a plug that doesnt fit and try another size, can we bill for the wasted supply?

Missouri Subscriber

Answer: Medicare does allow for the billing of wastage for injectables, such as Botox (botulinum). In the case of the injectables, they instruct providers to bill the total amount used and wasted on one claim.

In the above example of the plugs, Medicare does not have a written policy regarding the reimbursement of wastage caused by using the wrong size plug. To attempt to get the claim paid, add a note in the comments field of the claim indicating the reason you are submitting a claim for more than the typical number of plugs. If the carrier does not pay based on your comment, you will need to send the claim to review with a note explaining why you are billing the additional plugs.