When the ophthalmologist decides to place punctal plugs, selecting the procedure code seems easy as you have one code to select from. However if you do not append the right modifiers or provide medical necessity in the doctor’s documentation, you will see your reimbursements walk out of the door. Here are three simple steps to guarantee you will see payment on each plug placement procedure.
You don’t need to change procedure code based on plug type
Your ophthalmologist may use three types of punctal plugs that your ophthalmology may use: temporary collagen, semipermanent silicone, and intra-canalicular plugs. How you code the plug placement does not change based on the type of plug.
You don’t need to append modifiers to indicate anatomical location
For Medicare claims, you should append the E modifiers to the procedural code to indicate the plug’s location. You should append E1 (Upper left lid), E2 (Lower left lid), E3 (Upper right lid), or E4 (lower right lid) depending on where the ophthalmologist placed the puntal plug.
You don’t need to report supply based on carrier
Do not expect payment for puntal plug supplies from Medicare. The plugs haven’t been billable separately to Medicare and many local carriers for the past many years.
For more steps to ensure you get your payment on plug placement procedure and for other medical coding updates, sign up for a one-stop medical coding website. In fact, onboard such a site, you will get answers to all your coding queries under one roof. So why deprive yourself of this coding advantage!