Knowledge of the appropriate coding procedure is power—and helps you sleep in ~ night.

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By john Rumpakis, OD, MBA, Clinical Coding Editor


The capacity to do surgical steps is quickly becoming component of the OD’s main eye care duty and, for some, is already second nature.Mastering the clinical next of surgical measures is only half of the successful integration into practice; mastering the coding is the other.

Count the Days

Surgical measures follow their own set of rules, violation of i m sorry exposes ODs to the danger of one audit.

The first step to staying clear of this is understanding the difference between major and minor surgery, which revolves roughly the principle of the “global period.” The worldwide period, or worldwide surgical package, is a single payment for every care associated with a operation procedure. Payment is based on the 3 phases the a procedure: pre-, intra- and postoperative. The difference between major and young surgeries is the size (in days) that the an international period. Any surgical procedure with a global period of much less than 90 job is considered minor surgery. Any surgical procedure with a global period the 90 days is major. The rule differ significantly between the two. Let’s focus on boy surgical actions here.

Consolidate her codes

The vast majority of measures performed top top the cornea room minor, either through a zero- or 10-day global period. These encompass epilation (CPT 67820), corneal international body removal (65222), corneal debridement or curettage (65435), placement of amniotic membrane there is no sutures (65778) and occlusion of the puncta, by plug (68761).

In general, these space the rules surrounding minor surgical procedures:

There is no pre- or post-op duration associated v the code, so the an international period is just the day of the surgical procedure itself.Unless special scenarios exist, a separate office visit on the very same day as the surgical treatment is not billable or payable.

Billing for the office visit is commonly the stumbling block for ODs. The minor surgical codes currently include one office visit, therefore the carrier as necessary denies payment because that a 2nd office visit top top the same day. Many try to work around this by incorrectly using a modifier, thereby placing themselves at even greater threat of gift audited because that fraud.

The national Correct Coding plan (CCI) edits room explicit in addressing this issue and also have remove much of the ambiguity v this. Only “a significant and separately identifiable E&M business unrelated come the decision to perform the minor operation procedure is separately reportable through modifier 25. The E&M service and also minor operation procedure perform not require different diagnoses. If a minor operation procedure is perform on a brand-new patient, the exact same rules for reporting E&M services apply. The fact that the patience is ‘new’ to the provider is not enough alone to justification reporting one E&M service on the same date of company as a minor operation procedure.”1

This policy addresses the use of CPT comprehensive -25, among the most abused modifiers as reported by CMS, v a failure rate to meet necessity burden in an ext than 30% the claims.2

Other CCI edits impact your reporting process when performing multiple procedures on the very same day. Take into consideration a patient through a metallic corneal foreign body v a rust ring who calls for removal that both and also typically would have a bandage contact lens applied. You would certainly think the coding would be: 65222, 65435 and also 92071 (fitting of a contact lens for treatment of ocular surface ar disease).

However, based upon the CCI edits, 65222 and 65435 are currently bundled together, and also you space no longer enabled to bill for the fitting of a bandage lens on the same day as any kind of corneal procedure.1

So, for our clinical example, the coding and billing would certainly be 65222-RT/LT (modifiers used to specify best or left eye and also must correspond with laterality certain ICD-10), also if all three steps are performed.

Incorporating operation procedures right into your practice expands the depth of care you provide your patients and also community. Together you hone her clinical skills, make sure your coding an abilities keep pace to protect against preventable exposure and also risk.

Send her coding concerns torocodingconnection

1. NCCI Policy hand-operated 2020.

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2. Department of wellness & human being Services, Office that Inspector General. Usage of modifier 25. November 2005.