Ophthalmology and Optometry Coding Alert

Can't remember whether punctum closure has a 90- or 10-day global period? Don't be surprised, then, if your postoperative services reimbursements for this and other minor procedures come up short. Coding minor procedures can be a perplexing task, given that minor procedures can have both 0- and 10-day global periods and there are complicated rules for appending modifier -25 to boot. But if you know how to identify minor procedures and you know when you can separately bill an office visit by appending modifier -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service), your next chalazion removal will be a piece of cake. The first step to mastering minor procedures is to learn how to identify them. To many coders, this may seem like a no-brainer: The minor procedures are "starred," or followed by an asterisk, in the CPT manual & right? But watch out: If you use the starred procedures as the sole indicators of procedures classified as minor, you may be setting yourself up for inadequate reimbursement. For example, suppose a patient presents with dry-eye syndrome, the decline of quantity or quality of tears that results in constant eye irritation and potential scarring or ulceration of the cornea. The physician decides to insert punctum plugs in the patient's left and right lacrimal ducts to prevent moisture from draining out of the eyes. Two weeks later the patient returns with plug-related discomfort in his left eye. If the coder determined the initial procedure's global period strictly according to whether an asterisk followed the procedure, the coder missed out on reimbursement by assigning a 90-day global period to 68760 (Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery) - a procedure with a 10-day global period. The result: The coder mistakenly categorized the return visit as a procedure included in 68760's global surgical package simply because the procedure was not starred in the CPT manual. To keep track of the procedures that are starred in CPT 2002, many ophthalmology offices use the same asterisks as CPT to indicate minor procedures on their route slips or superbills. "We have our most common procedures divided up into cornea, lid, and anything that is a starred procedure [in CPT] has an asterisk. Whoever is in with the doctor knows this is a starred procedure or this is not a starred procedure," says Erica Kuntz, CPC, coding specialist with Northeast Ohio Eye Surgeons in Kent, Ohio. Understand Medicare's Take on Starred Procedures Although CPT 2002 considers minor procedures starred procedures, Medicare doesn't recognize this assertion, and more than half of the eye and ocular adnexa surgical procedures that have a 0-day or [...]