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Thread: Post Op Cataract Coding and Billing

  1. #1
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    Post Op Cataract Coding and Billing

    We just started doing Post op cataract surgery co-management and I am confused with coding. I know we are suppose to bill with cpt 66984 and modifier 55 on the CMS. But for my EHR (Examwriter) am I suppose to put that cpt 66984 in their since we did not provide the actual surgery. Can I bill on CMS if the CPT code was not put in the EHR or am I suppose to have that in my EHR also?

    Thanks in advance!

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    My Brain Hurts jpways's Avatar
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    The Exam code is 66984 and it should be put into your system so that you can process the payment when it comes in from Medicare. The 66984 codes is generally modified -54 for the surgical -55 for the post op care. An example I once saw that will either clear this up for you (or confuse you more).
    Suppose you have a multidoctor pratice with both OMDs and ODs.
    Dr. A, MD does the surgery and handles the first 20 days and then hands the post op to Dr. B, OD to handle the other 70 days.
    The office would post 2 66984s in the patient ledger
    66984-54 for Dr. A for the 20 Days
    and
    66984-55 for Dr. B for the 70 Days
    Your office is always Dr. B and would put a modified 66984 in your system (modified with 55).
    Now we use Eyecare Advantage, so I don't know if it is possible to do this in Examwriter. But, in the table where we set up our services with default charges, we can also put in default modifiers. So, when I enter 66984 it automatically adds the 55 modifier to the proper block to print.

    Now, notice I said that you should post it in your EHR. As far as billing the claim, I'm pretty sure Medicare (or any insurance company) does not require you to post the claims you submit into a billing system (EHR based or otherwise). You just need the proper exam records and supporting documents (in this case the letter/referral from the surgeon releasing the patient to your office for surgical comanagement) to support the code(s) that were billed. However, from an accounting/bookkeeping standpoint its better to post all procedures you bill into a ledger, if you use one, so that you can keep track of all claims and payments in case you need to followup or track them later.

  3. #3
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    and for all that trouble you get about $75-90 dollars right?

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    Quote Originally Posted by jpways View Post
    The Exam code is 66984 and it should be put into your system so that you can process the payment when it comes in from Medicare. The 66984 codes is generally modified -54 for the surgical -55 for the post op care. An example I once saw that will either clear this up for you (or confuse you more).
    Suppose you have a multidoctor pratice with both OMDs and ODs.
    Dr. A, MD does the surgery and handles the first 20 days and then hands the post op to Dr. B, OD to handle the other 70 days.
    The office would post 2 66984s in the patient ledger
    66984-54 for Dr. A for the 20 Days
    and
    66984-55 for Dr. B for the 70 Days
    Your office is always Dr. B and would put a modified 66984 in your system (modified with 55).
    Now we use Eyecare Advantage, so I don't know if it is possible to do this in Examwriter. But, in the table where we set up our services with default charges, we can also put in default modifiers. So, when I enter 66984 it automatically adds the 55 modifier to the proper block to print.

    Now, notice I said that you should post it in your EHR. As far as billing the claim, I'm pretty sure Medicare (or any insurance company) does not require you to post the claims you submit into a billing system (EHR based or otherwise). You just need the proper exam records and supporting documents (in this case the letter/referral from the surgeon releasing the patient to your office for surgical comanagement) to support the code(s) that were billed. However, from an accounting/bookkeeping standpoint its better to post all procedures you bill into a ledger, if you use one, so that you can keep track of all claims and payments in case you need to followup or track them later.
    Thank you! This medical billing is driving me crazy. But you explained it perfectly!

  5. #5
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    It's probably more like $200 to $250. It's not for an "exam". It's for a 90 day post operative period, all visits related to the surgery. The post op Doc can take over from day 1. The surgical doc and the post op Doc do not have to be in the same office or practice. It's been my experience that it only works with traditional medicare.

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