Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., Rebecca Wartman, O.D.
From the July/August 2016 edition of AOA Focus, page 45.
AOA's Coding Experts share solutions to your coding conundrums.
When should modifier 51 (multiple procedures) be used?
The 51 modifier can be used with any procedure (commonly thought of as surgery) such as epilation, punctal occlusion, or foreign body removal. It is not intended for use with diagnostic tests such as optical coherence tomography or visual field testing. It is prudent to also check with your local carriers and insurers. The complete definition of modifier 51 can be accessed at AOA Coding Today, an online, comprehensive database that contains information in real time for Current Procedural Terminology, ICD-10 and Healthcare Common Procedure Coding System coding and research. The website is tailored specifically to optometry and assists doctors and staff in correct reimbursement and compliance. Utilize AOA Coding Today as a free member resource to assist you immediately with your coding questions.
What is the postoperative global period for a corneal foreign body removal? Can I bill for follow-up visits after removal?
The easiest way to look up global periods is on the AOA Coding Today website. The global period for CPT 65222 is 0 days. As such, you can bill for follow-up visits. Global periods have recently been under scrutiny by the Centers for Medicare & Medicaid Services (CMS). In 2014, CMS proposed to transition all 10- and 90-day global services to 0-day globals. Congress intervened in the Medicare and Chip Reauthorization Act of 2015 (MACRA) to stop this significant change, but acknowledged that more should be known about services provided during global periods. Through MACRA, Congress directed CMS to collect information about the number and level of medical visits and other items and services related to the surgery that are furnished during the global period. CMS is currently working on how best to collect this data.
Ask the coding experts
Evaluation and management (E/M) services are incredibly important in patient care, and it’s critical that optometry practices are aware of changes ahead. Meanwhile, the AOA and other leading physician organizations are pushing legislation that would halt Medicare payment cuts resulting from the changes.
Time to review your practice’s billing and coding: Access national benchmark data for optometry practices and join an upcoming webinar to learn more about E/M code changes in 2021.