Every CPT code has been assigned a relative value unit (RVU) and they are determined on the basis of the resources necessary to the physician's performance of the service. Assigning these services in the proper sequence based on a highest to lowest RVUs can ensure proper payment. When submitting the claims, listing the codes in the wrong order may lower your reimbursements. Here are some examples which illustrates how a change in sequence may affect the way you are reimbursed. Case 1: During … [Read more...]
When should CPT Modifier-52 be used ?
Modifier-52 is used to describe circumstances in which services provided were reduced in comparison to the full description of the service. When a physician does not complete a procedure in its entirety the procedure must be billed by appending modifier-52 or in other words if a physician elects to partially reduce or discontinue the procedure for reasons other than the patients well being being threatned, modifier-52 may be used. Note: For hospital outpatient reporting of a previously scheduled … [Read more...]
Costly Coding and Billing Errors
Often in medical coding and billing , mistakes happens but if they are not addressed immediately or if they are overlooked, it could turn into a costly affair for the provider causing potential loss in revenue. In this series of coding and billing errors, we will try to highlight some of such common errors and their financial impact on the practice. CASE 1: A physician performed an arthrocentesis on the acromioclavicular joint bilaterally on a 74 year old female. The biller billed the CPT … [Read more...]
How to Bill Cataract Surgery with IOL Implant ?
When an opthalmologist performs extracapsular cataract removal with IOL insertion, the correct way to code the procedure is by using CPT code 66984 [Extracapsular cataract extraction removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique ( eg, irrigation and aspiration or phacoemulsification)]. However if there are any complications encountered during surgery such as removal of dense cataracts with application of indocyanine green or trypan blue … [Read more...]
How to Correctly bill Permanent Lacrimal Punctum Plugs?
CPT code 68761(closure of the lacrimal punctum; by plug, each) should be used to report the lacrimal procedure. This procedure is based on per puncta, not per eye so in situations where two puncta are treated in the same eye, multiple surgery rules apply. So report each service as a separate line item, adding modifier-51 to the second and any subsequent procedure. If performed in both eyes, bilateral payment rules apply, so report this procedure code with a modifier-50. This code is same whether … [Read more...]
How to Correctly Bill Deluxe Frames Post Cataract Surgery ?
Question: When a patient elects to upgrade his standard frame to a deluxe frame after cataract surgery, can a physician charge the differential even though he accepts assignment of benefits? Answer: Yes, you can. Medicare covers up to one pair of eyeglasses or one set of contact lenses after cataract surgery with IOL implantation. As such Medicare will only pay for the standard frames but if a beneficiary chooses to upgrade to a deluxe frame, the participating provider or supplier … [Read more...]
Workers’ Comp & PIP Claims : Common Mistakes Which Can be Avoided
When you are billing a Workers' Comp/PIP Claim, your success cautiondepends in part on whether your office captures all the pertinent information up front. When the patient first walks in and fills out the paperwork related to WC/PIP claim, often times it is incomplete, and/or illegible. Result - Confusion and delay in claims processing. By following these simple tips, you can avoid unnecessary delays in claims processing. 1. Obtaining accurate and complete information is not only vital in … [Read more...]
How to bill Pachymetry of the Cornea?
To bill pachymetry of the cornea, one should use CPT 76514 (cornealPachymetry of the cornea pachymetry, unilateral or bilateral). This code can only be used to report if the procedure is being performed using an Ultrasound technique. Since CPT 76514 is inherently bilateral it should not be reported with any site modifiers (RT or LT). Also it would be inappropriate to use modifier -50 with it. This service includes the interpretation and report, therefore no professional and technical modifiers … [Read more...]
How To Code An Intravitreal Injection?
When reporting intravitreal injection, one should bill CPT 67028, in addition to the drug used. For Avastin, use HCPCS code J9035(Injection, Bevacizumab,10 mg) and bill 1 unit. If the ophthalmolgist is injecting Avastin after a vitrectomy and the treatment is not an integral part of surgery, append modifier 59(Distinct Procedural services) in column 2 with CPT 60728. For Lucentis, use HCPCS code J2778(Injection, Ranibizumab, 0.1 mg) and bill the no. of units used. Don't forget to put … [Read more...]