Be careful of physician and billers coding, if they are not coders...
I don't normally code ophthalmology, and don't attempt to code procedures without an op note so I will not comment on the accuracy of the procedure codes billed. That said, I see three major E/M errors here that need to be addressed if you are to be paid correctly.
1.) You are billing for two E/M services (99204 & 99285) in each example, which I am assuming are for the same patient, doctor and date of service since you have stated that they are based on a claim submission. E/M coding guidelines will only allow one E/M service to be billed on each date of service, per TIN and physician specialty or subspecialty. If you are billing all of these codes under one doctor then you will never get paid as it stands. You would need to combine the documentation from both visits to bill one E/M code.
2.) There are also place of service issues with the E/M codes that you are using. You are billing one E/M code (99204) for a new patient visit in an office/outpatient setting, and the other (99285) which is an emergency department visit code. Even if the patient was seen in the office and then again in the ER on the same day, by the same physician or another under the same TIN and specialty, you still cannot bill two E/M codes. You would need to combine the documentation from both visits to bill one E/M code, using the E/M code set that is best suited for the location where the services were rendered.
3.) E/M services are included in the reimbursement for all services billed with the surgical section of CPT when the E/M is performed on the same day or within the global period of the procedure that is performed. Since both examples have multiple procedure codes billed, the E/M reimbursement would be included in the reimbursement for those procedures unless your documentation clearly supports the use of an E/M modifier, most likely 25 (since 24 does not apply and you have not coded for a major procedure (90-day global) to justify a 57). Two of the 3 procedure codes you have noted, 67840 and 68840, have a 10-day global period so all E/M services performed on the day of and the immediate 10 days after are covered under the procedure reimbursement. I would read up (and have your billers read up) on the appropriate use of all of the common CPT modifiers - 24, 25, 50, 51, 57, 58, 59, 78 and 79 to start - and familiarize yourself on situations speicifc to your office when they are appropriate, if you are not already familiar. I would also caution against the overuse of modifier 25 since this modifier has been on the OIG hit list for several years and may trigger an audit.
Hope all of this helps you, your billers and doctors, and most importantly your reimbursement!
One last note, here is a link to a good article about the appropriate use of the 99281-99285 emergency department E/M codes.
http://www.findacode.com/medicare/p...-medicare-info.php?type=ARTICLE&type_id=42979