2019 Ophthalmology CMS ICD-10 Updates

This week the Centers for Medicare and Medicaid Services (CMS) released the ICD-10-CM updates for FY 2019. The 2019 ICD-10-CM codes are to be used for patient encounters and discharges occurring from October 1, 2018 through September 30, 2019. Below is a list of ICD-10 code changes that impact ophthalmology.

For the ICD-10 codes below: new codes include upper and lower eyelids for right and left eye, including canthus.

  • C43.1 Malignant melanoma of eyelid, including canthus
  • C43.10 Malignant melanoma of unspecified eyelid, including canthus
  • C43.11 Malignant melanoma of right eyelid, including canthus
  • C43.111 Malignant melanoma of right upper eyelid, including canthus
  • C43.112 Malignant melanoma of right lower eyelid, including canthus
  • C43.12 Malignant melanoma of left eyelid, including canthus
  • C43.121 Malignant melanoma of left upper eyelid, including canthus
  • C43.122 Malignant melanoma of left lower eyelid, including canthus
  • C4A.1 Merkel cell carcinoma of eyelid, including canthus
  • C4A.10 Merkel cell carcinoma of unspecified eyelid, including canthus
  • C4A.11 Merkel cell carcinoma of right eyelid, including canthus
  • C4A.111 Merkel cell carcinoma of right upper eyelid, including canthus
  • C4A.112 Merkel cell carcinoma of right lower eyelid, including canthus
  • C4A.12 Merkel cell carcinoma of left eyelid, including canthus
  • C4A.121 Merkel cell carcinoma of left upper eyelid, including canthus
  • C4A.122 Merkel cell carcinoma of left lower eyelid, including canthus
  • C44.1 Other and unspecified malignant neoplasm of skin of eyelid, including canthus Excludes 1: connective tissue of eyelid (C49.0)
  • C44.10 Unspecified malignant neoplasm of skin of eyelid, including canthus
  • C44.101 Unspecified malignant neoplasm of skin of unspecified eyelid, including canthus
  • C44.102 Unspecified malignant neoplasm of skin of right eyelid, including canthus
  • C44.1021 Unspecified malignant neoplasm of skin of right upper eyelid, including canthus
  • C44.1022 Unspecified malignant neoplasm of skin of right lower eyelid, including canthus
  • C44.109 Unspecified malignant neoplasm of skin of left eyelid, including canthus
  • C44.1091 Unspecified malignant neoplasm of skin of left upper eyelid, including canthus
  • C44.1092 Unspecified malignant neoplasm of skin of left lower eyelid, including canthus
  • C44.11 Basal cell carcinoma of skin of eyelid, including canthus
  • C44.111 Basal cell carcinoma of skin of unspecified eyelid, including canthus
  • C44.112 Basal cell carcinoma of skin of right eyelid, including canthus
  • C44.1121 Basal cell carcinoma of skin of right upper eyelid, including canthus
  • C44.1122 Basal cell carcinoma of skin of right lower eyelid, including canthus
  • C44.119 Basal cell carcinoma of skin of left eyelid, including canthus
  • C44.1191 Basal cell carcinoma of skin of left upper eyelid, including canthus
  • C44.1192 Basal cell carcinoma of skin of left lower eyelid, including canthus
  • C44.12 Squamous cell carcinoma of skin of eyelid, including canthus
  • C44.121 Squamous cell carcinoma of skin of unspecified eyelid, including canthus
  • C44.122 Squamous cell carcinoma of skin of right eyelid, including canthus
  • C44.1221 Squamous cell carcinoma of skin of right upper eyelid, including canthus
  • C44.1222 Squamous cell carcinoma of skin of right lower eyelid, including canthus
  • C44.129 Squamous cell carcinoma of skin of left eyelid, including canthus
  • C44.1291 Squamous cell carcinoma of skin of left upper eyelid, including canthus
  • C44.1292 Squamous cell carcinoma of skin of left lower eyelid, including canthus
  • C44.13 Sebaceous cell carcinoma of skin of eyelid, including canthus
  • C44.131 Sebaceous cell carcinoma of skin of unspecified eyelid, including canthus
  • C44.132 Sebaceous cell carcinoma of skin of right eyelid, including canthus
  • C44.1321 Sebaceous cell carcinoma of skin of right upper eyelid, including canthus
  • C44.1322 Sebaceous cell carcinoma of skin of right lower eyelid, including canthus
  • C44.139 Sebaceous cell carcinoma of skin of left eyelid, including canthus
  • C44.1391 Sebaceous cell carcinoma of skin of left upper eyelid, including canthus
  • C44.1392 Sebaceous cell carcinoma of skin of left lower eyelid, including canthus
  • D03.1 Melanoma in situ of eyelid, including canthus
  • D03.10 Melanoma in situ of unspecified eyelid, including canthus
  • D03.11 Melanoma in situ of right eyelid, including canthus
  • D03.111 Melanoma in situ of right upper eyelid, including canthus
  • D03.112 Melanoma in situ of right lower eyelid, including canthus
  • D03.12 Melanoma in situ of left eyelid, including canthus
  • D03.121 Melanoma in situ of left upper eyelid, including canthus
  • D03.122 Melanoma in situ of left lower eyelid, including canthus
  • D04.1 Carcinoma in situ of skin of eyelid, including canthus
  • D04.10 Carcinoma in situ of skin of unspecified eyelid, including canthus
  • D04.11 Carcinoma in situ of skin of right eyelid, including canthus
  • D04.111 Carcinoma in situ of skin of right upper eyelid, including canthus
  • D04.112 Carcinoma in situ of skin of right lower eyelid, including canthus
  • D04.12 Carcinoma in situ of skin of left eyelid, including canthus
  • D04.121 Carcinoma in situ of skin of left upper eyelid, including canthus
  • D04.122 Carcinoma in situ of skin of left lower eyelid, including canthus
  • D22.1 Melanocytic nevi of eyelid, including canthus
  • D22.10 Melanocytic nevi of unspecified eyelid, including canthus
  • D22.11 Melanocytic nevi of right eyelid, including canthus
  • D22.111 Melanocytic nevi of right upper eyelid, including canthus
  • D22.112 Melanocytic nevi of right lower eyelid, including canthus
  • D22.12 Melanocytic nevi of left eyelid, including canthus
  • D22.121 Melanocytic nevi of left upper eyelid, including canthus
  • D22.122 Melanocytic nevi of left lower eyelid, including canthus
  • D23.1 Other benign neoplasm of skin of eyelid, including canthus
  • D23.10 Other benign neoplasm of skin of unspecified eyelid, including canthus
  • D23.11 Other benign neoplasm of skin of right eyelid, including canthus
  • D23.111 Other benign neoplasm of skin of right upper eyelid, including canthus
  • D23.112 Other benign neoplasm of skin of right lower eyelid, including canthus
  • D23.12 Other benign neoplasm of skin of left eyelid, including canthus
  • D23.121 Other benign neoplasm of skin of left upper eyelid, including canthus
  • D23.122 Other benign neoplasm of skin of left lower eyelid, including canthus

G51 Facial nerve disorders

  • G51.31, clonic hemifacial spasm, right
  • G51.32, clonic hemifacial spasm, left
  • G51.33, clonic hemifacial spasm, bilateral
  • G51.39, clonic hemifacial spasm, unspecified

H01.0 Blepharitis, Unspecified

  • H01.001, upper right lid
  • H01.002, lower right lid
  • H01.00A, upper and lower right lids
  • H01.004, upper left lid
  • H01.005, lower left lid
  • H01.00B, upper and lower left lids

H01.0 Blepharitis, Ulcerative

  • H01.011, upper right lid
  • H01.012, lower right lid
  • H01.01A, upper and lower right lids
  • H01.014, upper left lid
  • H01.015, lower left lid
  • H01.01B, upper and lower left lids

H01.0 Blepharitis, Squamous

  • H01.021, upper right lid
  • H01.022, lower right lid
  • H01.02A, upper and lower right lids
  • H01.024, upper left lid
  • H01.025, lower left lid
  • H01.02B, upper and lower left lids

H02.88 Meibomian gland dysfunction of eyelid

  • H02.881, upper right lid
  • H02.882, lower right lid
  • H02.88A, upper and lower right lids
  • H02.884, upper left lid
  • H02.885, lower left lid
  • H02.88B, upper and lower left lids

H02.2 Lagophthalmos, cicatricial

  • H02.211, upper right lid
  • H02.212, lower right lid
  • H02.21A, upper and lower right lids
  • H02.214, upper left lid
  • H02.215, lower left lid
  • H02.21B, upper and lower left lids
  • H02.21C, bilateral, upper and lower lids

H02.2 Lagophthalmos, mechanical

  • H02.221, upper right lid
  • H02.222, lower right lid
  • H02.22A, upper and lower right lids
  • H02.224, upper left lid
  • H02.225, lower left lid
  • H02.22B, upper and lower left lids
  • H02.22C, bilateral, upper and lower lids

H02.2 Lagophthalmos, paralytics

  • H02.231, upper right lid
  • H02.232, lower right lid
  • H02.23A, upper and lower right lids
  • H02.234, upper left lid
  • H02.235, lower left lid
  • H02.23B, upper and lower left lids
  • H02.23C, bilateral, upper and lower lids

H02.2 Lagophthalmos, unspecified

  • H02.201, upper right lid
  • H02.202, lower right lid
  • H02.20A, upper and lower right lids
  • H02.204, upper left lid
  • H02.205, lower left lid
  • H02.20B, upper and lower left lids
  • H02.20C, bilateral, upper and lower lids

H10.82 Rosacea conjunctivitis

  • Code first underlying rosacea dermatitis (L71.-)
  • H10.821 Rosacea conjunctivitis, right eye
  • H10.822 Rosacea conjunctivitis, left eye
  • H10.823 Rosacea conjunctivitis, bilateral
  • H10.829 Rosacea conjunctivitis, unspecified eye

H57.8 Other specified disorders of eye and adnexa

  • H57.811 Brow ptosis, right
  • H57.812 Brow ptosis, left
  • H57.813 Brow ptosis, bilateral
  • H57.819 Brow ptosis, unspecified
  • H57.89 Other specified disorders of eye and adnexa
  • H57.9 Unspecified disorder of eye and adnexa

The Gold Standard of Outsourcing: Increase Your Revenue with Eye Med Management Solutions

The Gold Standard of Outsourcing: Increase Your Revenue with Eye Med Management Solutions

Cost cutting may be a big factor when looking to outsource, but it’s not the only reason to consider. Outsourcing your medical billing can significantly increase your revenue stream and efficiency. Every business wants to hire the best people, with the best education and credentials, and in turn produce the best results. When you outsource your ophthalmology billing with Eye Med Management Solutions that is exactly what you are getting.

There is value in experience. We bring over thirty years of ophthalmology billing experience to our clients. Medical billing is always going to be done better and with detailed precision by the experts. Lost revenue due to inexperience can add up to thousands of dollars at the end of the year. We have a successful, streamlined billing process and guarantee you will see results. There is a reason why the system of checks and balances is valuable. It’s good to have another set of eyes looking at your accounts and processes to make sure things are running smoothly. We know the challenges practices face and we bring a unique perspective to help deal with these challenges. This is what sets us apart.

In today’s world you have access to a much larger talent pool than the fifty mile radius around your office. Why limit your employee resources to your immediate geographic area? We specialize in ophthalmology and we hire the best in the industry. Outsourcing can help small practices act "big" by giving them access to the same economies of scale, efficiency, and expertise that large companies enjoy.

Outsourcing can also reduce labor costs in the office. Hiring and training staff is time consuming, expensive, and some employees don’t always live up to your expectations. Eye Med Management Solutions has the resources to start projects right away with no down time or lag in your billing. Handling the same project in-house might involve taking weeks or months to hire the right people, train them, and provide the support they need. All of this allows your practice to focus on medicine and patient care. Every business has limited resources, and every manager has limited time and attention. Outsourcing can help your business shift its focus from peripheral activities toward work that serves the customer, and it can help managers set their priorities more clearly.

The insurance industry is complex; full of red tape and enormous amounts of paperwork. Eye Med Management Solutions has a proven system is place to process and submit claims and handle follow up issues. Whether it’s your business website, your accountant, an HR consultant, computer guru, or your ophthalmology billing firm, outsourcing has a powerful impact on productivity, growth, and your bottom line. Building a successful, profitable practice requires resources outside of your immediate office staff.  We’re the best in the business and our results speak for themselves.

 

Cataract Surgery Billing and Coding Tips

Cataract Surgery Billing and Coding Tips

June is Cataract Awareness Month and we’re giving you our top billing and coding tips for cataract surgery. Cataracts are the leading cause of vision loss in the United States, affecting over 22 million people. To reduce the risk of an audit and get paid correctly and in a timely manner, it’s imperative that your documentation is correct.

One of the biggest mistakes when billing for cataract surgery is billing for the same eye twice. It may sound obvious, but many practices have made this mistake. When billing the second eye in a post op period, append modifier -79 with the eye modifier (RT, LT). Always double check the claim prior to submission to verify the correct eye. Per Medicare Local Coverage Determinations (LCDs), the patient must fill out the VF-14, a commonly referenced scale of determining the visual effect of cataracts on a patient’s activity of daily living. Questions include:

  • Driving during the day/night

  • Reading small print on medicine bottles, telephone book, food labels

  • Reading a newspaper or book

  • Reading large print book or large print newspaper or numbers on a telephone

  • Recognizing people when they are close to you

  • Seeing steps, stairs, or curbs

  • Reading traffic signs, street signs, or store signs

  • Doing fine handiwork, sewing, knitting, crocheting, or carpentry

  • Filling out forms

  • Playing games such as bingo, dominoes, and cards

  • Taking part in sports like bowling, tennis, golf

  • Cooking

  • Watching television

Other documentation you must include in the chart note: evidence of the patient’s preoperative best-corrected visual acuity; record of visual distortion or complaints of glare associated with functional impairment; documentation supporting visual acuity improvement with the removal of the cataract; a signed operative report; and, documentation showing the patient understands the risks, benefits, and expected outcomes of surgery, and most importantly, desires cataract surgery.

  • 66984: Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual or mechanical technique (i.e. irrigation and aspiration or phacoemulsification); also known as ECCE. This is the standard method of cataract surgery where the natural lens (cataract) is removed along with the anterior shell. The posterior shell of the lens capsule is left in place.
    • Payment is per eye and is the number one procedure performed in ASC’s. For ultrasonic determination of intraocular lens power, use 92136 or 76519.

  • 66982: Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual or mechanical technique (i.e. irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (i.e. iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage.

    • Payment is per eye, secondary fixation of IOL is included. Complex cases are roughly 5% of cataract surgeries performed.

    • Indications for coding complex cataract surgery include:

      • A miotic pupil that will not dilate sufficiently to allow operative access to the lens and that requires the insertion of one of the following: four iris retractors through four additional incisions; Beehler expansion device; a sector iridectomy with subsequent suture repair of; iris sphincter; or sphincterotomies created with scissors.

      • The presence of a disease state that produces lens support structures that are abnormally weak or absent. This requires the need to support the lens implant with permanent intraocular sutures, or a capsular tension ring may be necessary to allow placement of an intraocular lens.

      • Pediatric cataract surgery.

Coding Tips for Common Ophthalmology Services: Part Two

Coding Tips for Common Ophthalmology Services: Part Two

This is the second blog in a two part series on common ophthalmology services and how to avoid billing errors. To reduce the risk of an audit and costly billing mistakes, here are some tips on common ophthalmology tests and procedures.

  • Fluorescein angiography. Use CPT code 92235, Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral. This test is used for evaluating retinal, choroidal, and iris blood vessels, as well as any eye problems affecting them. Fluorescein dye is injected into an arm vein, then rapid, sequential photographs are taken of the eye as the dye circulates. The cost of the dye is not separately payable and this code does not include fundus photos (CPT 92250). When medically necessary this test is payable during the global postoperative period whether related or unrelated to the surgery.
  • Fundus photography. Use CPT code 92250, Fundus photography with interpretation and report. Fundus photography is a process of using special optical imaging equipment to document the diagnosis and treatment of diseases of the eye. Fundus photography may be indicated to document abnormalities related to a disease process affecting the eye, or to follow the course of such disease. It also lends itself to the assessment of a wide variety of retinal disorders. Photography documenting external eye abnormalities may also be necessary. Payment for this test is bilateral. When medically necessary this test is payable during the global postoperative period whether related or unrelated to the surgery.
  • Excision of lesion. The CPT code to use depends on the size of the lesion: 68110 (excision of lesion, conjunctiva, up to 1cm), 68115 (excision of lesion, conjunctiva, over 1 cm), 68130 (excision of lesion, conjunctiva, with adjacent sclera). The criteria for modifier -25 must be met when billing an established patient office visit the same day that CPT code 68110 or 68115 is performed. Payment is per eye. A biopsy and excision of the same lesion are not payable on the same day. CPT codes 68110 or 68115 are appropriate for pinguecula excision based on size. For Medicare Part B patients, when surgery is performed bilaterally, submit one line item with the surgical code appended by modifier -50, with a 1 in the unit field and the charge doubled.
  • Trabeculoplasty. Use CPT code 65855, trabeculoplasty by laser surgery; also known as ALT or SLT. This laser surgery removes part of the trabecular meshwork to increase outflow of aqueous from the eye; a type of filtering surgery used in the treatment of glaucoma. Known as Argon laser trabeculoplasty (ALT), Micropulse laser trabeculoplasty (MLT), and Selective laser trabeculoplasty (SLT). Payment is per eye. The global period for Medicare patients is 10 days. The global period for non-Medicare patients is 90 days. Modifier -57 should be appended to the office visit when an ALT/SLT is performed the same day for a non-Medicare patient. Do not report 65855 with 65860, 65865, 65870, 65875, 65880.

 

Coding Tips for Common Ophthalmology Services: Part One

Coding Tips for Common Ophthalmology Services: Part One

We’ve all heard the saying “it takes a village” - and this includes ophthalmology billing and coding. Exams, testing, and minor and major surgical procedures all take a team to coordinate and complete. The physician is ultimately responsible for selecting the proper code, however, it takes a team effort to properly document, code, and bill for these services. In this two-part series, we are giving you a review of frequent services and how to avoid billing mistakes.

  • Foreign body removal. Use CPT code 65222, Removal of foreign body, external eye; corneal, with slit lamp. This code has a zero day global period and is paid per eye. When the patient comes back a few days later for a follow up visit, it is a billable exam. If a rust ring develops, 65222 is the CPT code to use.
  • Benign skin lesions. The CPT code to use depends on the size of the lesion: 11440 (diameter of 0.5 cm or less), 11441 (0.6 to 1 cm), 11442 (1.1 to 2 cm), 11443 (2.1 to 3 cm), 11444 (3.1 to 4 cm), or 11445 (4 cm or greater). Medicare and non-Medicare payers cover benign skin lesion removal with proper documentation. A photograph is beneficial in the patient’s medical record. The chief complaint should include words like red, growing in size, oozing, and itching. Since this procedure may be considered cosmetic, it is helpful to obtain an ABN from the patient. Adding modifier –GA to the claim shows that an ABN is on file.
  • Punctum plugs. Use CPT code 68761, closure of the lacrimal punctum; by plug, each. This code has a ten day global period and is paid per eye. If both eyes were done, use 1 unit, modifier -50. This code has a Medically Unlikely Edit (MUE) of 4 per Medicare, meaning “ the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.” In most cases of dry eye syndrome requiring punctum plugs, placement of one plug in each lower punctum will alleviate the problem, in which Medicare will reimburse for two plugs per patient on a single date of service. Two additional plugs may be done (total of 4), and documentation must show the two additional plugs were medically necessary.
  • A-scan ultrasound and IOL Master for intraocular lens calculations. Use CPT code 76519 when billing for an A-scan, ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation. Use CPT code 92136 when using an IOL Master, ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation. Medicare and most commercial payers have a global technical component, modifier –TC, and each eye has a professional component, modifier -26. You may come across a few payers who do not recognize these modifiers, in which case use –RT and –LT.