As glaucoma specialists, we tend to develop a quick and ready insight into how to treat our patients. Unfortunately, our intuitive powers usually do not extend to coding for treatment. Even top glaucoma doctors can fall into a trap if their staff cannot decode, unbundle, link, modify, and submit accurate requests for reimbursement.

The scenarios presented in Table 1 are designed to help you and your office personnel hone your coding skills. I suggest that you and your staff set aside some time to review the scenarios, identify potential problems, and determine the best way to resolve coding conflicts.

GLOBAL FEE PERIODS AND MODIFIERS
You can avoid most of the coding conflicts described in Table 1 by being aware of global fee periods. Carriers may deny any claims filed for additional evaluations or procedures performed during a previous procedure's global fee period unless the code includes the proper modifiers. The modifiers you will use most often are:

  • -57: office visit to decide major surgery during global fee period;
  • -78: return to OR for related procedure during postoperative period;
  • -79: unrelated procedure during postoperative period;
  • -24: unrelated office visit during postoperative period; and
  • -25: separate office visit on same day of unrelated service.

EXAMPLES
Scenario No. 4 from Table 1, in which a patient returns 1 week after an iridotomy with a complaint of ocular burning and irritation, is a good example of a common billing mistake. If more than one employee is involved in the patient's care, everyone may not be aware that the visit occurred during the global fee period, and a separate bill may be submitted for the evaluation (Eye Code 92012 [intermediate eye examination]). The claim will be denied, because the reason for the visit is related to the laser procedure.

We avoid this problem in my office by noting the procedure and its global fee period on a readily visible area of the patient's chart.

In some situations (scenario Nos. 7, 14, and 17), you are eligible for reimbursement for an office visit if it occurs during the postoperative period for an unrelated procedure (-24) or on the same day as an unrelated service (-25). The office visit will also be covered if its purpose is to decide whether to proceed with major surgery during a global fee period (-57), as described in scenario Nos. 1, 6, and 13.

When you are in a global fee period for a procedure performed on one eye, payment for any procedure to the second eye will be denied unless you append modifier -79 to the appropriate code (scenario Nos. 5, 9, 10, and 15). In some cases, (scenario No. 15) the modifier for the second case (-58) starts a new global fee period, but the same is not true for the use of modifier -78 (scenario No. 13.)

SUMMARY
The coding examples described herein are just a small sample of the situations you may encounter in your practice. Reviewing these test cases with your staff will start a process that will improve your practice's coding efficiency and accuracy. Once you have laid the groundwork, you can keep your skills up to date by:

  1. periodically attending coding seminars;
  2. reviewing a few charts at random once a month to see if they can survive an audit;
  3. reviewing claims denied by your carrier. This practice is one of the best ways to learn about coding and will prevent you from repeating mistakes; and
  4. showing your staff how to use new codes.

Most importantly, do not get frustrated. Although coding can be complicated, it can be personally and financially rewarding if you pay attention to the details.

Ronald L. Fellman, MD, OCS, is a glaucoma specialist at Glaucoma Associates of Texas in Dallas. He is also a certified Ophthalmic Coding Specialist. Dr. Fellman may be reached at (214) 360-0000; fellman@aol.com.