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Ophthalmology and Optometry Coding Alert

You Be the Coder:

Plug Reinsertion

Published on Wed May 01, 2002

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: For a Medicare patient, how should I code reinsertion of temporary punctal plugs or permanent plugs?

Indiana Subscriber

Answer: If the procedure is performed in the operating room within the global period of the original insertion, report 68761 (Closure of the lacrimal punctum; by plug, each) with modifier -78 (Return to the operating room for a related procedure during the postoperative period). When billing for multiple procedures, be sure to append modifier -78 first, then modifier -51 (Multiple procedures). If all four puncta are closed, use three modifiers: -78, -51, and the eyelid modifier (-E1, -E2, -E3 and -E4). Claim systems recognize only two modifiers, so use modifier -99 (Multiple modifiers) and place the modifiers in the comments area or in box 19. The claim will look like this:
 
  • 68761-78-E1
     
  • 68761-78-99
     
  • 68761-78-99
     
  • 68761-78-99
    •  In the comments area or box 19, list the following:
    -51-E2, -51-E3, -51-E4.

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