Ophthalmology and Optometry Coding Alert

Don't accept payment reductions, or you could lose up to 50% on every claim When you report "add-on" codes for ophthalmic endoscopy or prolonged physician services, do you know the special rules that apply? If you can keep just four points in mind, you can gain the best possible reimbursement for your add-on procedures every time. Point 1: Look for the '+' To identify add-on codes in CPT, you should look for a "+" symbol to the left of the code. Also, all add-on codes contain a variation of the phrase "list separately in addition to code for primary procedure" in their CPT descriptors. A typical add-on code listing appears as follows: +66990 (Use of ophthalmic endoscope [list separately in addition to code for primary procedure]).

"The 'plus' designation identifies those codes that the physician performs in addition to other, usually closely related, procedures or services," says Tara L. Conklin, CPC, an instructor for CRN-Institute, a coding and reimbursement institution offering courses in reimbursement, medical billing, outpatient coding certification, and inpatient coding certification. "That's why they are called 'add-on' codes: You cannot report them alone, but always 'add them on' to another procedure or service."

Here's an example: A surgeon would never report +67335 (Placement of adjustable suture[s] during strabismus surgery, including postoperative adjustment[s] of suture[s]) unless he was already performing strabismus surgery -- for example, 67311 (Strabismus surgery, recession or resection procedure; one horizontal muscle).  

Because you would only bill 67335 in addition to another procedure, CPT lists the code as an add-on.

Some E/M services qualify as add-on codes, as well. For instance, you may report prolonged services -- such as +99354 (Prolonged physician service ...; first hour) and +99355 (... each additional 30 minutes) -- only in addition to other, primary E/M services such as outpatient visits or consultations.
 
Note: For a complete list of add-on codes, see Appendix D of CPT. Point 2: Always List With a Primary Procedure You should never list an add-on code without also listing a primary procedure. Rather, the add-on code describes additional intraservice work associated with specific primary procedures the physician performs during the same operative session or patient encounter, says Anita L. Carter, LPN, CPC, an instructor at A+ Medical Management and Education, a school for billing and coding in Absecon, N.J. In most cases, the primary code(s) for a given add-on code immediately precede the add-on code in the CPT listings. For example, consider the following CPT code sequence:

67221 -- Destruction of localized lesion of choroid (e.g., choroidal neovascularization); photodynamic therapy (includes intravenous infusion)

+67225 -- ... photodynamic therapy, second eye, at single session (list separately in addition to code for primary eye treatment). In this case, the add-on code (67225) follows the related [...]