natashalage
Guru
Hello coding professionals,
I am a new Ophthalmology coder and have a dilemma with coding the Op Note below. My fellow coders code this as 68840 - because canalicula is mentioned but to me it's 68810 because the 'duct' was done. What is your rational and code to such note? Sometimes MDs describe the procedure like "Canalicula: soft stop but free to irrigation. Nasalacrimal Duct: 100% reflux OD with mucus and 0% reflux OS"- they code as 68840 because 'canalicula' is mentioned. Another example: Canalicula: patent x4. NC Duct: 70% reflux.."- 68840 I am very puzzled and not convinced of the rational and will greatly appreciate your input and expertise in it.
Thank you.
![4099 4099](https://www.aapc.com/discuss/data/attachments/3/3211-95157d283f76e5c6bc440b10446d4dbd.jpg)
I am a new Ophthalmology coder and have a dilemma with coding the Op Note below. My fellow coders code this as 68840 - because canalicula is mentioned but to me it's 68810 because the 'duct' was done. What is your rational and code to such note? Sometimes MDs describe the procedure like "Canalicula: soft stop but free to irrigation. Nasalacrimal Duct: 100% reflux OD with mucus and 0% reflux OS"- they code as 68840 because 'canalicula' is mentioned. Another example: Canalicula: patent x4. NC Duct: 70% reflux.."- 68840 I am very puzzled and not convinced of the rational and will greatly appreciate your input and expertise in it.
Thank you.
![4099 4099](https://www.aapc.com/discuss/data/attachments/3/3211-95157d283f76e5c6bc440b10446d4dbd.jpg)