Wiki Punctal Plugs billing to Medicare??

[tracibarnes]

How do you bill Medicare for Punctal Plugs. I recently billed

99213-25

68761 RT E3 E4
68761 LT E1 E2
W/ Diagnosis H02.88B AND H02.88A W/ Diagnosis pointer attached to corresponding eye.

Medicare paid the E and M code but not the punctal plugs.

I could not find any recent posts about this on Medicare's site or on this forum.

Also does anyone know how often you can bill these to Medicare?

 

[Cheezum51]

I think your ICD code should be H04.123. Also, you should have a 51 modifier for each subsequent plugs.
68761 E3
68761 51 E4
68761 51 E1
68761 51 E2

Also, if the patient was there specifically for puncatl plugs, then the OV shouldn't have been billed.

Tom Cheezum, OD, CPC, COPC

 

[HEakin]

Medicare requires modifier 50 on clinic and profee claims.
They won't pay for all 4 units, it's a bilateral procedure.

Dr. Cheezum is correct, they won't pay for that dx code.
Try dry eye, keratitis, epiphoria due to insufficient drainage, or recurrent erosion if it was discussed.

 

[Cheezum51]

Medicare requires modifier 50 on clinic and profee claims.
They won't pay for all 4 units, it's a bilateral procedure.

Dr. Cheezum is correct, they won't pay for that dx code.
Try dry eye, keratitis, epiphoria due to insufficient drainage, or recurrent erosion if it was discussed.

I thought it VERY odd that all four puncta would be occluded at the same visit and would have been surprised if all4 had been paid.