Ophthalmology and Optometry Coding Alert

A patient came in for a punctum snip incision 68440* (snip incision of lacrimal punctum) and the ophthalmologist saw something on the lid that he thought required a biopsy 67810* (biopsy of eyelid). The billing for this code combination requires two separate diagnoses two separate medical necessities, explains Lise Roberts, vice president of Health Care Compliance Strategies, a coding and compliance consulting firm based in Jericho, N.Y.

Because code 67810* has a higher relative value unit (RVU) than 68440*, list it first on the claim form with the appropriate ICD-9 diagnosis code, and list 68440* second with modifier -51 (multiple procedures), indicating there were two procedures performed. Roberts says that if your payer does not recognize -51, do not append it to 68440*. The star (*) by 67810* and 68440* in CPT 2000 indicates they are minor surgical procedures with a zero-to-10-day global surgical package.

You cannot bill for an office visit, however. A visit is billable if you document a history, exam and medical decision-making, and the reason for the exam was to determine either what the condition was or what the appropriate treatment would be, says Roberts. If the patient had been seen previously for the problem for which the snip incision was performed, and the plan for the snip incision was made then, a visit would not be separately billable. In this scenario, however, the physician noticed a lesion and performed a biopsy as a precaution. If he had taken a history, or if he had done more than take a quick external look with the slit lamp, he could bill an office visit. But this scenario would not justify billing an office visit because no significant, identifiable service took place.