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Use of 92018 by ASC

  1. Default Use of 92018 by ASC
    Medical Coding Books
    A physician did an examination under anesthesia at our center. This is the OP Note:



    DESCRIPTION OF PROCEDURE: This patient was brought to the operative suite and then sedated and placed initially with a mask and then later with an LMA for her examination under anesthesia. Prior to any major induction her pressure were around 6-10 in the right eye and around 30 in the left. Shortly after she was intubated with an LMA pressure was around 20 in the right and 33 in the left. About 10-15 minutes later the pressures were 17 in the right and 22 in the left. All these consistently higher in the left eye than the right, of course. Corneal diameters were average in both at about 10 mm and the anterior segment by slit lamp exam was normal with just underdevelopment of the iris stromal detail. Gonioscopy was performed and she had a congenital angle with poorly developed angle recess but not PAS seen. A-scans were done and a 22.47 axial length for the right and a 22.87 axial length for the left were noted. Pachymetry was done and it was 629 in the right and 627 in the left. Fundus exam showed completely normal periphery, other than a pale fundus in general from a lightly complected patient and the optic nerves were about 0.7 in the right and 0.8 in the left with some thinning of the temporal rim on the left. Retinoscopy was performed and the conversion to a manifest is roughly -5, +1, axis 90 in the right and -550, +50, axis 90 in the left, indicating a moderate nearsightedness in both eyes.

    Our impression then is that the patient has elevated pressure in the left eye and some cupping in the left eye, thick cornea and an underdeveloped angle recess and iris system from disc genesis of the anterior segment, question whether treatment with some pressure lowering medication might be helpful for the left eye and will talk to the parents about this. Patient was taken off the LMA, awakened and sent to the recovery room in satisfactory condition with no complications.

    My question is this-we filed to BC who denied the charge as "alternate procedure is missing or is an invalid relationship. We billed with 92018, no modifiers. Can you tell me if we are right in billing 92018 and if we need modifier(s)? Thanks!

  2. Default
    This procedure service rendered reveals not only gonioscopy but also other tests like slit lamp exam, tonometry, etc.
    Can consider coding initially 92004/92014 and then the other tests as may be required;
    Lavanya Mohan

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