More Billing & Coding

modifiers

• provide additional information about a procedure/service billed

• used when a service/procedure was unusual

• used to break a procedure into its components

26

modifier ____: professional component applicable to special testing, indicates test was interpreted only, not performed

TC

modifier ____: technical component applicable to special testing, indicates test was only performed, not interpreted

TC

which modifier is needed in this scenario:

your practice owns an OCT & another local OD sends their pt for OCT w/o interpretation or office visit

26

which modifier is needed in this scenario:

you are the OD who ordered the OCT to be done at another practice, therefore you only interpreted it

none

which modifier is needed in this scenario:

you performed & interpreted the OCT on your patient

50

modifier ____: used when a service is performed on 2 eyes when the code is unilateral, applicable to special testing/procedures

50

which modifier is needed in this scenario:

therapeutic CL is fit for both eyes

53

modifier ____: pre-operative, used with a procedure code

54

modifier ____: surgical care only, used with a procedure code

55

modifier ____: post-operative, used with a procedure code

F

T/F: you can use E/M, medical eye codes, & vision codes w/ surgical coding

T

T/F: if within the global period, all visits that are related to the surgery or any complications will be covered under surgical billing & can’t be billed separately

T

T/F: you can still bill for a refraction during the post op period

1. surgery date

2. discharge date (transfer of care)

3. ICD 10 code used

what do you need to pull from the surgeon’s report at the first post-op visit?

1. same code that the surgeon used

2. cataract extraction codes

3. presence of IOL code

what is the order of codes for the first post-op visit after cataract surgery?

1. cataract extraction codes

2. presence of IOL codes

what is the order of codes for subsequent post-op visits after cataract surgery (NOT the first visit)?

T

T/F: you bill the no charge post-op CPT code at subsequent post-op visits after the post-op code is used at the initial post-op visit

F

T/F: you need to include the cataract extraction codes at all visits even after the global period is over

when you evaluate refractive error or assess the implant

when should you include the presence of IOL code after the global period is over?

medical

a diabetic eye exam is a _____ complaint

lower

reimbursement for a diabetic eye exam is _____ through routine vision plans

diabetes

to bill a diabetic eye exam medically, the _______ must be the first ICD 10 & thus the cc

self-limited or minor problem

• problem definition:

  • Problem that runs a definite or prescribed course

  • Transient

  • Unlikely to alter permanent health status

• examples:

  • Subconj heme

  • Mild viral conjunctivitis that doesn’t require intervention

  • Mild hordeolum that doesn’t require intervention

  • Mild allergic conjunctivitis that doesn’t require intervention

acute uncomplicated illness/injury

• problem definition:

  • Recent problem, short term

  • Low risk of morbidity

  • Little to no risk of mortality with tx

  • Full recovery is expected

  • Might be self limited but doesn’t have a definite resolution course

• examples:

  • Hordeolum

  • Allergic conjunctivitis

  • Mild corneal abrasion

stable acute illness

• problem definition:

  • Acute illness that has stabilized

  • used on a lot of f/u when condition was initially higher risk

• examples:

  • Pt had severe corneal ulcer but w/ tx, condition has stabilized & prognosis is good or predictable

acute illness w/ systemic symptoms

• problem definition:

  • Illness causes systemic sx (general or single system)

  • High risk of morbidity w/o tx

• examples:

  • Acute CN palsy associated w/ COVID-19

acute complicated injury

• problem definition:

  • Tx requires eval of body systems that aren’t part of injured organs, injury is extensive, there are multiple tx options, or there is risk of morbidity w/ tx

• examples:

  • Pt presents w/ diplopia following head injury & determine pt still needs further work-up with other health care specialists due to effects in other organ systems

stable, chronic illness

• problem definition:

  • Expected to last at least 1y or until pt’s death

  • Tx goal has been met (doesn’t necessarily matter if it hasn’t changed)

  • Risk of morbidity must be significant w/o tx

• examples:

  • Glaucoma, target IOP is 17 & pt has met that

  • Amblyopia, goal was to achieve 20/25 or better vision & that has been met

chronic illness w/ exacerbation, progression, or SE of tx

• problem definition:

  • Chronic illness that is worsening, not well controlled, progressing, requires additional care, or has SE from treating this condition that now need to be managed

  • High risk of morbidity

  • Pt might require hospital care

• examples:

  • Worsening cataracts

  • Worsening DR

  • Worsening DE

  • Child on atropine for amblyopia, SE of near blur warrants tx w/ reading glasses

  • Neovascular glaucoma

  • CNVM from AMD

  • PDR

acute or chronic illness that poses a threat to life or bodily function

• problem definition:

  • Short term severe threat

• examples:

  • RD

  • Arteritic anterior ischemic optic neuropathy

  • Orbital cellulitis

  • Retinoblastoma

  • Choroidal melanoma

  • Severe central corneal ulcer

rest, superficial bandage, no f/u care needed, observation only

what are some examples of minimal risk tx/management?

Bruder mask, AT, lid hygiene, Amsler grid, patching for amblyopia, home-based VT, SPRx, Lumify, Pataday,

what are some examples of low risk tx/management?

in office VT, Meibomian gland expression, atropine therapy for amblyopia, any Rx drugs

what are some examples of moderate risk tx/management?