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Coding for Dry Eyes Coding for Dry Eyes
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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)
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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
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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
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External ocular External ocular photographyphotography
CCI CCI 9202092020 (-59 ok)(-59 ok)
9921199211 (-59 ok)(-59 ok)
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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
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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.
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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)
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Punctum PlugsPunctum Plugs
Doctor OrderDoctor OrderNoNo
Supervision LevelSupervision LevelDoes not applyDoes not apply
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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
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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
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Coding for Dry Eyes Coding for Dry Eyes
Meibomian Probe Meibomian Probe
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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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