Coding for Dry Eyes 1. 92285 External ocular photography, documentation of medical progress (eg,...

Coding for Dry Eyes Coding for Dry Eyes

11

Coding for Dry Eyes Coding for Dry Eyes

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

External ocular External ocular photographyphotography

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

External ocular External ocular photographyphotography

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

External ocular External ocular photographyphotography

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

9921199211 (-59 ok)(-59 ok)

66

External ocular External ocular photographyphotography

Interpretation and reportInterpretation and reportYesYes

Doctor OrderDoctor OrderYesYes

Supervision LevelSupervision LevelGeneralGeneral

77

Coding for Dry Eyes Coding for Dry Eyes

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

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Coding for Dry Eyes Coding for Dry Eyes

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

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Coding for Dry Eyes Coding for Dry Eyes

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

Coding for Dry Eyes Coding for Dry Eyes

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

Punctum PlugsPunctum Plugs

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

Punctum PlugsPunctum Plugs

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.

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Punctum PlugsPunctum Plugs

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

Punctum PlugsPunctum Plugs

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

Punctum PlugsPunctum Plugs

Doctor OrderDoctor OrderNoNo

Supervision LevelSupervision LevelDoes not applyDoes not apply

1717

Punctum PlugsPunctum Plugs

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

Punctum PlugsPunctum Plugs

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

Punctum PlugsPunctum Plugs

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

Punctum PlugsPunctum Plugs

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

Punctum PlugsPunctum Plugs

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

Punctum PlugsPunctum Plugs

Great billing summary:Great billing summary:

Lacrimedics.comLacrimedics.com

2323

Coding for Dry Eyes Coding for Dry Eyes

LipiFlowLipiFlow

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

2424

Coding for Dry Eyes Coding for Dry Eyes

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

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