Ophthalmic Coding Specialist Questions And Answers With Verified Solutions

Ophthalmic Coding Specialist Questions And Answers With Verified Solutions An established patient presents for an exam with the chief complaint of a red irritated eyelid. The diagnosis is blepharitis. The patient also has diabetes and recently received a comprehensive eye exam. What should the diagnosis for today's exam be? ✔✔Blepharitis only. The primary diagnosis should relate to the chief complaint. A 64 year old patient has cataract surgery. Now, at age 65, the patient obtains post cataract glasses. Is this a covered benefit? ✔✔Yes, HCPCS code V2020 Frames, purchases. What is the correct code to use when removing a rust ring using the slit lamp? ✔✔CPT code 65222 Removal of foreign body, external eye; corneal, with slit lamp. When coding Evaluation and Management services, what is indicative of a moderate level of risk? ✔✔1. Minor surgery with identified risk factors. 2. Elective major surgery with no identified risk factors. 3. Prescription drug management Prior to inserting punctal plugs, what documentation should be noted in the medical record? ✔✔1. Complaint indicating dry eye symptoms such as burning, excessive tearing, sensitive to light, etc. 2. Evidence that other methods of treatment have proven unsuccessful. 3. Documentation of tear/glad deficiency or a Schirmer tear test. The correct CPT code when inserting collagen punctal plugs is? ✔✔CPT code 68761 Closure of the lacrimal punctum; by plug, each. True or False - All punctal procedures are payable per puncta . ✔✔False. Only CPT code 68761. Closure of the lacrimal punctum; by plug, each, is payable puncta. All other lacrimal procedures are payable per eye. True or False - Glare testing, brightness acuity testing, and potential acuity measurement, are separately payable. ✔✔False. These tests are included, but not countable elements of an exam. Besides the patient's health/vision insurance, what other payers may be responsible for an ophthalmic exam? ✔✔Workers Compensation, home owner insurance, and automobile in surance. True or False - Category 3 codes such as 0099T Implantation of intrastromal corneal ring segments, are for new technology. As such they are not assigned an allowable or a global period until there is a payer specific coverage policy. ✔✔True True or False - Medical records should be documented in black or blue ink. ✔✔False. However since medical records need to be copied on occasion, black and blue ink make the duplication easier to read. Major surgical global period includes: ✔✔The management of c omplications following surgery, unless a return to the operating room is required. When documenting and coding E&M codes, the following qualifies for what level of new patient exam? 1. A detailed history. 2. A detailed exam. 3. Medical decision making of low complexity. ✔✔CPT code 99203. G0117 Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist, is a an example of what level of CPT code? ✔✔Level 2 CPT. A detailed exam documents how many elements of the eye? ✔✔9 to 12 elements True or False - The Advance Beneficiary Notice (ABN) is a recognized document for all payers. ✔✔False. Only Medicare recognizes the ABN. A new ABN replaced the current document as well as the Notice of Exclusion of Medicare Benefits (NEMB). This document became effective September 1, 2008. It can be viewed under Coding Tools at aao.org. True or False - When performing special ophthalmic testing services, a physician must always be on site. ✔✔True and False. While Medicare recognizes three levels of supervision, i.e., general, direct, and personal, non -Medicare payers only recognize direct supervision where a physician of the practice is on site. Inherently bilateral payment for special testing services means...? ✔✔Payment is for testing one or both eyes. It is no longer necessary to append modifier -52 indicating reduced procedure or the RT or LT modifiers. Medical reason for only testing one eye should be indicated in the medical record. A patient undergoes cataract extraction and corneal transplantation at the same surgical encounter. The CPT code should be listed first on the claim form to appropriately maximize reimbursement? ✔✔CPT code 65730 K eratoplasty (corneal transplant); penetrating (except in aphakia), has the highest relative value units so it should be listed first. If the cataract extraction were listed first, payment would be approximately $450.00 less. True or false - Evaluation and Management codes are nationally recognized by all payers. Eye code documentation requirements vary by state and payer. ✔✔True