When should the charge for ultrasound biometry

When should the charge for ultrasound biometry with IOL calculations be submitted to insurance: on the day it is done and interpreted, or on the day the cataract surgery is performed?


Answer: In most Medicare carrier areas, the A-scan can be billed when it is performed; you do not have to wait until the cataract surgery. A few Medicare carriers still require that the date of surgery be entered on the claim in the note or comment field when billing for this procedure, but most do not. Check with your Medicare carrier for any unique claim filing requirements they may have.

HCFA policy even allows the A-scan to be billed for both eyes at the same time when both cataracts will be operated on within a short time frame. This is why most Medicare carriers no longer require the A-scan to be billed on the day of surgery.

Answers contributed by Lise Roberts, vice president, Health Care Compliance Strategies, Jericho, N.Y.; Raequell Duran, president, Practice Solutions, Santa Barbara, Calif.; and Michael X. Repka, MD, American Academy of Ophthalmology representative to the CPT Advisory Committee.

NCCI 11.3 Update: Include Duct Probe in Dacryocystorhinostomy

The latest bundles also clarify the rules for IOL exchanges
You probably won’t tear up when you see what NCCI is up to this quarter--unless your practice spends a fair share of its time performing nasolacrimal probes.

NCCI version 11.3, that took effect Oct. 1, specifies that CPT codes 68810 (Probing of nasolacrimal duct, with or without irrigation) and 68811 (… requiring general anesthesia) are included in:

• 31239--Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy

• 68530--Removal of foreign body or dacryolith, lacrimal passages

• 68720--Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity).


Translation: You can no longer report 68810 or 68811 along with those three codes unless it is a separate procedure, marked with modifier 59 (Distinct procedural service).

Additionally, NCCI has determined that 68840 (Probing of lacrimal canaliculi, with or without irrigation) is included in 68530 and 68700 (Plastic repair of canaliculi).

NCCI 11.3 also addresses IOL insertions and exchanges. IOL insertion procedure 66985 (Insertion of intraocular lens prosthesis [secondary implant], not associated with concurrent cataract removal) includes 65920 (Removal of implanted material, anterior segment of eye) as a component, so you should not report those two codes together unless you can justify appending modifier 59. Code 66986 (Exchange of intraocular lens) now also includes 66985, since NCCI identifies 66986 as a “more extensive” procedure.

Removal of implanted material (65920) is already bundled into IOL exchanges (66986), says Christina Hollis, OCS, coder and surgery scheduler at Pediatric Ophthalmology Associates in Columbus, Ohio.

Bottom line: Don’t attempt to report an IOL exchange by using both 66985 and 65920. The NCCI edits have assigned a bundling modifier “1” to these codes, so unless there is evidence of a separate anatomical site (separate eye), reporting these procedures together is prohibited. If the ophthalmologist both removes an old IOL and inserts a new IOL, report 66986, which specifically describes IOL exchanges.

Coding 65920 with 66986 is inappropriate “because the removal of the IOL is an integral part of an IOL exchange,” Hollis says. “You’d basically be paid twice for removing the IOL. The same reasoning applies to 66985 and 66986--you’d be paid twice for inserting the new lens.”

Note: NCCI 11.3 takes effect on Oct. 1. To download the complete set of NCCI 11.3 edits, visit the Web site www.cms.hhs.gov/physicians/cciedits.

No Need for Ob-Gyn's Presence on TC/26 Code

Question: We-re charging for a fetal non-stress test (NST). Is it OK if the ob-gyn was not present on the day the patient underwent the NST?

The code for the NST (59025, Fetal non-stress test) has both a technical (modifier TC, Technical component) and professional component (modifier 26, Professional component) and no requirement for direct physician supervision. 

Important: If your ob-gyn wasn't present for the NST performed at the hospital and documented the interpretation, you should report 59025-26. The hospital would then report 59025-TC. If the patient underwent the NST in the office, you should report 59025 alone.