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Opthalmology coding help please!

  1. Unhappy Opthalmology coding help please!
    Exam Training Packages
    I'm still new at these opthalmology procedures and I'm confused. I work obviously at an ASC so I wanted to be sure that these codes were ok to use here and if I am missing something? Here is the op report:

    POSTOPERATIVE DIAGNOSIS:
    Aphakia, both eyes.

    OPERATION:
    1. Bilateral examination under anesthesia.
    2. Biometry by ultrasound echo A-scan.
    3. Biometry by ultrasound echo with power calculation.

    ANESTHESIA:
    General.

    COMPLICATIONS:
    None.

    INDICATIONS:
    The risks, benefits, and alternatives to an examination under anesthesia were discussed with the patient's mother and she elected to proceed.

    DESCRIPTION OF PROCEDURE:
    The patient was brought to the operating room suite in stable condition and inducted under general anesthesia without complications. Both eyes were examined first with the slit-lamp.

    The anterior segment showed clear and quite bulbar conjunctiva. The cornea was clear. The anterior chamber was deep and quite. The patient was aphakic OU. The posterior segment examination showed retinas to be flat 360 degrees bilaterally. Optic nerves were with sharp margins. There was no significant cuffing. A-scan readings for the right eye were as follows, 22.4, 20.35, 20.24, 20.25, 20.26, 20.27, 20.32, 20.31, 20.35, and 20.41. A-scan readings for the left eye were as follows, 20.57, 20.58, 20.63, 20.69, 20.67, 20.71, and 20.75. Keratometry readings for the right eye were as follows, 44.50/48.25, 42.75/48.37, 44.50/47.62, and 43.75/48.12. Keratometry readings for the left eye were as follows, 44.75/46.87, 44.62/44.87, 43.75/43.87, and 44.00/47.25. Applanation tonometry readings showed the pressures to be 10-15 mmHg, each eye.


    I came up with:
    92018
    76516
    76519

    Am I even close? I guess I'm confused at the fact that these codes are in the Medicine section and Radiology part of the book and I know we are limited at ASC's for codes in these sections to use. It's a Medicaid patient.

    Your help is much appreciated!!

  2. #2
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    you did good...but highly unlikely that there will be any reimbursement from Medicaid on this case

  3. Default
    Thank you Mary! I figured that since they are not on our list of Medicaid ASC covered procedures, I'm not sure why we took the case here but what's done is done. Have you had any experience with any other payers covering these codes for an ASC? Just for future reference?

  4. #4
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    Quote Originally Posted by smcbroom View Post
    Thank you Mary! I figured that since they are not on our list of Medicaid ASC covered procedures, I'm not sure why we took the case here but what's done is done. Have you had any experience with any other payers covering these codes for an ASC? Just for future reference?
    I've never had to use them in the ASC

  5. Unhappy
    If anyone else out there has any experience with these can you let me know?
    Thanks again Mary!

  6. #6
    Location
    Iowa City, IA
    Posts
    18
    Question 92018
    Does any one know which modifier would be correct to append to the 92018 to unbundle a CCI edit - 25 or 59?

  7. #7
    Default
    You don't code 90000 codes in an ASC. Nor do you use modifier 25. 92018 is not billable in an ASC. 76516 and 76519 have a payment indicator of Z3 radiological services paid seperatly when integral to a surgical procedure
    you would use the TC modifier for Technical component due to being the facility and not the physician.

  8. #8
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    I disagree lgentry..92018 is a procedure that is performed under general anesthesia and is billable in an ACS setting. It may not be paid for by some carriers based on contracts (IE Medicare), however the code is billable in an ASC setting.

    Lindaskin..25 is not an ASC approved modifier, 59 would be the most appropriate if you documentation warrants the use thereof
    Mary, CPC, CANPC, COSC

  9. #9
    Default
    I stand corrected mbort.... my experience is with surgery centers with mainly Medicare patients so I appreciate being reminded that if contracted 92018 and 92019 are billable but rarely get paid....

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