Coding for Dry Eyes

1
Coding for Dry Eyes
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Coding for Dry Eyes

• 92285 External ocular photography, documentation
  of medical progress
• (eg, close-up photography, slit lamp
  photography, goniophotography, stereo-photography)
  

3
External ocular photography

• Indications, Diagnosis Codes, Frequency
• Medicare LCD
• Noridian No
• CGS Yes
• WPS No
• Novitas No
• Palmetto No

4
External ocular photography

• Indications, Diagnosis Codes, Frequency
• Non-Medicare
• Every plan has own rules
• Clinical judgment
• May follow Medicare

5
External ocular photography

• Unilateral / Bilateral
• CPT Silent
• Medicare Bilateral, Payment same whether one
  or both eyes
• Non-Medicare No universal rule, may follow
  Medicare

6
External ocular photography

• CCI
• 92020 (-59 ok)
• 99211 (-59 ok)

7
External ocular photography

• Interpretation and report
• Yes
•  
• Doctor Order
• Yes
• Supervision Level
• General

8
Coding for Dry Eyes

• Lab
• 83861 Microfluidic analysis 23.58 (WA)
• TearLab Osmolarity System www.tearlab.com
• Waived test
• Must have certificate of waiver

9
Coding for Dry Eyes

• Lab
• Certificate of Waiver 150 for 2 yr (WA)
• Medicare co-payments deductibles do not apply

10
Coding for Dry Eyes

• Lab
• Touch Scientific Lactoferrin MicroAssay System
  by Corneal Science
• Moderate complexity test
• License 450 per 2 year training

11
Coding for Dry Eyes

• Punctum Plugs
• 68761 Closure of the lacrimal punctum by plug,
  each
•  
• -Bill same for all types (Herrick, SmartPlug),
• all materials (collagen, silicone, etc).
• -Supply of plug bundled by Medicare
• non-Medicare may pay.

12
Punctum Plugs

• Indications, Diagnosis Codes, Frequency Medicare
  LCD
• Noridian No
• CGS No
• WPS No
• Novitas Yes
• Palmetto No

13
Punctum Plugs

• Indications, Diagnosis Codes, Frequency
  Non-Medicare
• Every plan has own rules
• Clinical judgment
• May follow Medicare

14
Punctum Plugs

• Surgical Report
• Not a coding requirement, for Medical-Legal.
• Pre-printed form with check boxes.
• Sample upon request.

15
Punctum Plugs

• Unilateral / Bilateral
• Medicare Non-Medicare
• Payment is per puncta, not per eye.

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Punctum Plugs

• CCI
• 68761
• 68440 (-59 ok) (Snip incision of lacrimal
  punctum)
• 68801 (-59 ok) (Dilate punctum)
• 68810 (-59 ok) (Probe nasolacrimal duct)

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Punctum Plugs

• Doctor Order
• No
• Supervision Level
• Does not apply
•  

18
Punctum Plugs

• Modifiers
• 4 Plugs
• 68761-E1 left upper lid
• 68761-E2-51 left lower lid
• 68761-E3-51 right upper lid
• 68761-E4-51 right lower lid
•  

19
Punctum Plugs

• Modifiers
• 2 Plugs
• 68761-E1 left upper lid
• 68761-E3-51 right upper lid
•  
• 51 Multiple procedures

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Punctum Plugs

• Consent Form
• -Not a coding requirement.
• -Medical-Legal document.
• -Optional, unless liability insurer requires.

21
Punctum Plugs

• Global Period
• Medicare
• 10 days, follow-up visit paid after 10th day
  post-op.
• Non-Medicare
• Varies, 0 to 15 days.

22
Punctum Plugs

• Payment
• -100 of 1st procedure, 50 of subsequent
  procedures.
• -Important bill 100 of UC for all procedures.

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Punctum Plugs

• Great billing summary
• Lacrimedics.com

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Coding for Dry Eyes

• LipiFlow
• Paul Jensen OD, Renton/Bellevue

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Coding for Dry Eyes

• Meibomian Probe

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Ocular Side Effects

• file//localhost/Users/alanhomestead/Documents/My
  Documents B 3-8-13/Adventures 11-3-12/O -
  S/Presentations/Repository of My PowerPoints/1
  Topic Modules/Ocular SE Sys Med/Oc SE Aug 13.ppt