Your doctor sees an established patient with severe dry eye who has not been on artificial tear products of any kind. Your practice documents this in the patient’s chart, and the doctor recommends both frequent use of artificial tears and punctal plugs in both lower lids.
Is this enough to support your claim for the plugs? The answer is “maybe” — your patient’s insurance might not think so if they have written specific guidance. Note: If you ask about the exam on the same day as a minor procedure, that was discussed in a previous OP article on modifier 25 (See tinyurl.com/OPCodingJuly15).
This article addresses the following topics:
Will they pay?
This article was published in Ophthalmic Professional’s Coding column, and written by Corcoran’s Senior Consultant, Paul Larson, COE. To view the entire article in Ophthalmic Professional, click on the link below: