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Ophthalmology and Optometry Coding Alert

Reader Question:

Punctal Plugs

Published on Mon Dec 24, 2012

Question: Current coding uses the -E1 to -E4 codes with 68761 (closure of the lacrimal punctum; by plug, each), 68801* (dilation of lacrimal punctum, with or without irrigation), and A4263 (permanent, long-term, nondissolvable lacrimal duct implant, each). When an office visit is coded with punctal plug service and more than one plug is inserted (usual case), this forces more than six entries on the HCFA form and results in a split claim. When filed electronically (usual case), many if not most payers arent able to link the two claim pieces together and deny one set of codes as dupes. This forces appeals to correct their mistake, which ultimately gets paid, but its a lot of work. Has anyone had success using the -50 modifier (bilateral procedure) and/or units of two to four with plugs? Medicare says they dont need any modifiers, but I dont trust them to process correctly when [...]
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