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2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

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Click here for more sample CPC practice exam questions and answers with full rationale

Complicated Coding issue involving Cataract surgery on a juvenile for PCS Cataract su

I would like some Coding help in determining What CPT’s and what current ICD-10 Codes can be billed for cataract surgery with sulcus lens placement, pars plana vitrectomy, with lens implant retrieval of implant that dropped into the vitreous space during surgery, right eye. This is complicated in that the cataract surgery was performed by the Primary Ophthalmologist on a juvenile patient for PSC cataract OD and then this patient experienced a posterior capsule rupture during I & A necessitating pars plana vitrectomy with lens implant retrieval by another Ophthalmologist, who is the Retinal Surgeon in the same Ophthalmology Practice. Also, can this be coded as a Two-Surgery Case with a -62 modifier on each surgery? Also, the CPT Codes the Retinal Surgery said to use for his portion of the surgery were 67036, 67121, and 66986.

Which modifiers would I use for each surgery for each provider?

Medical Billing and Coding Forum

Coding for Vitrectomy and Cataract in the same setting

If I’m billing Medicare, How would I code these 2 services for coverage? The DX code for the cataract SX (66984) is H25.811 and for the Vit (67042) I have DX code H35.371.
Medicare denied me on this claim, I was wondering if I needed to add a modifier 51 to get paid for these services that were done on the same DOS.

Medical Billing and Coding Forum

Anthem BCBS Denying 2nd Eye Cataract Surgery

Is anyone having issues with Anthem denying/rejecting the second eye cataract surgery within global of the first eye as "modifier used is inconsistent with procedure?"

66984 – RT w/ ICD-10: H25.811
66984 – 79, LT w/ ICD-10: H25.812

We have never had issues before and cannot get through to a live provider or customer service rep. Thank you for any suggestions.

Medical Billing and Coding Forum

CTR insertion during cataract removal

Has anyone ever had their doc insert a capsular tension ring during the same surgery that he removes a cataract? [It is in preparation for the IOL to be inserted to the sulcus (vs. the lens capsule) at a later surgery.] Have you figured out how to bill for the insertion of the CTR?

Thanks!

Medical Billing and Coding Forum

Help with billing cataract surger done on MC patient in Skilled Nursing

We billed a cataract surgery 66984 plus the reporting G codes to Novitas (We are an ASC in TX). Novitas paid and then denied/recouped due to the patient being in a SNF at the time of her surgery.
Is there a modifier that could have been used on this? 54 for Surgical Care Only??
We were told to send the claim and op notes, etc to the SNF in which we did and now we are unable to get ahold of them.
Any help would be much apprectiated.

Janet

Medical Billing and Coding Forum

Cataract surgery post-op care only

When patients from our optometry practice are diagnosed with cataracts they are referred to a surgeon. Following surgery the patient returns to our optometry practice for postoperative management only. We see the patient anywhere from 1-3 weeks postop. The surgeon provides us with a transfer of care letter with the information that we need to bill. We bill the same cataract code as the surgeon, with a modifier -55. If the patient is having both eyes done, they will return again for postoperative management of the second eye. When the patient is seen for postop visits for the second eye, should I use modifier -55 as well as -79 because the patient is in a global period from the first surgery? Does our optometry office need to base our fee on the number of postop days that we are treating the patients? How do we know what 20% of the charge is? The surgeons do not share the fee with us. Thank you.

Medical Billing and Coding Forum