coding for dry eyes 1. 92285 external ocular photography, documentation of medical progress (eg,...

Coding for Dry Eyes Coding for Dry Eyes

11


9228592285 External ocular photography, External ocular photography, documentation of medical progress documentation of medical progress

(eg, close-up photography, slit lamp (eg, close-up photography, slit lamp photography, goniophotography, stereo-photography, goniophotography, stereo-photography) photography)

22

External ocular External ocular photographyphotography

Indications, Diagnosis Codes, Indications, Diagnosis Codes, FrequencyFrequency

Medicare LCDMedicare LCDNoridian: Noridian: NoNo

CGS: CGS: YesYes

WPS:WPS: NoNo

Novitas:Novitas: NoNo

Palmetto: Palmetto: NoNo33


Indications, Diagnosis Codes, Indications, Diagnosis Codes, FrequencyFrequency

Non-MedicareNon-Medicare

Every plan has own rulesEvery plan has own rules

Clinical judgmentClinical judgment

May follow MedicareMay follow Medicare

44


Unilateral / Bilateral Unilateral / Bilateral CPT: CPT: SilentSilent

Medicare: Medicare: Bilateral, Payment same Bilateral, Payment same whether one or both eyeswhether one or both eyes

Non-Medicare: Non-Medicare: No universal rule, may No universal rule, may follow Medicarefollow Medicare

55


CCI CCI 9202092020 (-59 ok)(-59 ok)

9921199211 (-59 ok)(-59 ok)

66


Interpretation and reportInterpretation and reportYesYes

Doctor OrderDoctor OrderYesYes

Supervision LevelSupervision LevelGeneralGeneral

77


LabLab8386183861 Microfluidic analysis $23.58 (WA)Microfluidic analysis $23.58 (WA)

TearLab Osmolarity System TearLab Osmolarity System www.tearlab.comwww.tearlab.com

Waived testWaived test

Must have certificate of waiver Must have certificate of waiver

88


LabLabCertificate of Waiver $150 for 2 yr Certificate of Waiver $150 for 2 yr (WA)(WA)

Medicare co-payments & deductibles do not Medicare co-payments & deductibles do not apply apply

99


LabLabTouch Scientific Lactoferrin MicroAssay Touch Scientific Lactoferrin MicroAssay

System by Corneal ScienceSystem by Corneal Science

Moderate complexity testModerate complexity test

License $450 per 2 year + trainingLicense $450 per 2 year + training

1010


Punctum PlugsPunctum Plugs68761 68761 Closure of the lacrimal punctum; by Closure of the lacrimal punctum; by

plug, eachplug, each

-Bill same for all types -Bill same for all types (Herrick, SmartPlug)(Herrick, SmartPlug), , all materials all materials (collagen, silicone, etc).(collagen, silicone, etc).

-Supply of plug bundled by -Supply of plug bundled by MedicareMedicare; ;

non-Medicare non-Medicare maymay pay. pay.1111

Punctum PlugsPunctum Plugs

Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Medicare LCDMedicare LCD

Noridian: Noridian: NoNo

CGS: CGS: NoNo

WPS:WPS: NoNo

Novitas:Novitas: YesYes

Palmetto: NoPalmetto: No1212


Indications, Diagnosis Codes, Indications, Diagnosis Codes, Frequency Frequency Non-MedicareNon-Medicare

Every plan has own rulesEvery plan has own rules

Clinical judgmentClinical judgment

May follow MedicareMay follow Medicare

1313


Surgical ReportSurgical ReportNot a coding requirement, for Medical-Not a coding requirement, for Medical-

Legal.Legal.

Pre-printed form with check boxes.Pre-printed form with check boxes.

Sample upon request.Sample upon request.

1414


Unilateral / Bilateral Unilateral / Bilateral

Medicare & Non-Medicare:Medicare & Non-Medicare:

Payment is per puncta, not per eye.Payment is per puncta, not per eye.

1515


CCI CCI 68761 +68761 +6844068440 (-59 ok)(-59 ok) (Snip incision of lacrimal punctum)(Snip incision of lacrimal punctum)

6880168801 (-59 ok)(-59 ok) (Dilate punctum)(Dilate punctum)

6881068810 (-59 ok)(-59 ok) (Probe nasolacrimal duct)(Probe nasolacrimal duct)

1616


Doctor OrderDoctor OrderNoNo

Supervision LevelSupervision LevelDoes not applyDoes not apply

1717


ModifiersModifiers4 Plugs4 Plugs

68761-E168761-E1 left upper lid left upper lid

68761-E2-5168761-E2-51 left lower lidleft lower lid

68761-E3-5168761-E3-51 right upper lidright upper lid

68761-E4-5168761-E4-51 right lower lidright lower lid

1818


ModifiersModifiers2 Plugs2 Plugs

68761-E168761-E1 left upper lid left upper lid

68761-E3-5168761-E3-51 right upper lidright upper lid

51 = Multiple procedures51 = Multiple procedures

1919


Consent FormConsent Form-Not a coding requirement.-Not a coding requirement.

-Medical-Legal document.-Medical-Legal document.

-Optional, unless liability insurer requires.-Optional, unless liability insurer requires.

2020


Global Period Global Period MedicareMedicare

10 days, follow-up visit paid after 1010 days, follow-up visit paid after 10thth day day post-op.post-op.

Non-MedicareNon-Medicare

Varies, 0 to 15 days.Varies, 0 to 15 days.

2121


PaymentPayment

-100% of 1st procedure, 50% of subsequent -100% of 1st procedure, 50% of subsequent procedures.procedures.

-Important: bill 100% of U&C for all -Important: bill 100% of U&C for all procedures.procedures.

2222


Great billing summary:Great billing summary:

Lacrimedics.comLacrimedics.com

2323


LipiFlowLipiFlow

Paul Jensen OD, Renton/BellevuePaul Jensen OD, Renton/Bellevue

2424


Meibomian Probe Meibomian Probe

2525

Ocular Side EffectsOcular Side Effects

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

2626

coding for dry eyes 1. 92285 external ocular photography, documentation of medical progress (eg,...

Documents

eyes nonmedicare

punctum plugs indications

punctum plugs payment

punctum plugs modifiers

punctum plugs cci

silent medicare

dry eyes punctum plugs

punctum plugs doctor