SACME Questions for 2018 Codequest Arkansas Ophthalmological Society | January 25, 2018 Question Title * 1. 6-year-old boy under general anesthesia has 3 chalazia excised at the ASC; Two upper right and one upper left. Correct claim submission for CPT code 67808 Chalazion excision under general anesthesia and/or requiring hospitalization, single or multiple is: 67808. CPT description states single or multiple 67808 with a 3 in the unit field 67808 -E3 + 67808 -E1 67808 -50 + 67808 -E3 OK Question Title * 2. No matter the payer, documentation requirements prior to bilateral upper eyelid functional blepharoplasties include: Visual fields taped and untaped; Photos; and Functional complaint in the patient’s own words. True False. Many payers no longer require visual fields – only photos! If not required, do not submit for payment. Make sure patients’ complaint is functional not cosmetic OK Question Title * 3. The anti-VEGF drug you inject is free. Which of the following statements is correct? If the drug is free, the injection should not be billed either. Bill the injection only. Bill the injection at the usual and customary fee + drug with a $0 charge. Bill the injection + the drug at the usual and customary fee. OK Question Title * 4. Medicare Mom from Florida (First Coast) undergoes cataract surgery in her left eye. Her daughter who lives in Georgia (Cahaba) prearranges for Mom to receive all postop care while staying with her. Which of the following statements is true? Comanagment can occur across state lines with different MACS. Comanagement can’t occur. Georgia ophthalmologist can bill E/M or Eye visit codes. OK Question Title * 5. If I am only injecting 25 units of Botox for blepharospasm, then the wise choice is to draw from the cosmetic 50-unit vial rather than the 100-unit vial. True False OK Question Title * 6. When the surgeon removes tubes, sutures or gold weights outside of the global period, is this billbable? Yes No OK Question Title * 7. When is it appropriate to adjust off commercial payer copays, deductibles and balances? Staff Professional courtesy Friends and family Infrequent charitable circumstances Never OK Question Title * 8. A practice hires a new ophthalmologist and is in the process of credentialing. During the waiting period, the new ophthalmologist sees patients and bills for services under the senior ophthalmologists NPI. Is this correct billing? Yes No OK Question Title * 9. When an exam, CPT code 92240 ICG and CPT code 92250 Fundus photos are performed on the right eye, how should the claim be submitted? Exam -25, 92240 -RT, 92250 Exam -25, 92240 -59 -RT, 92250 Exam, 92240, 92250 Exam, 92240 -59 -RT, 92250 Exam, 92240. 92250 is bundled into 92240. 92240 is inherently bilateral. OK Question Title * 10. A new patient who is in the hospital is transported to our office for an examination. They are then transported back to the hospital. How is the claim submitted? Office exam, POS 11 (office) Hospital exam, POS 21 (hospital) Office exam, POS 21 (hospital) Hospital exam, POS 11(office) OK Question Title * 11. Patient is s/p cataract surgery, OD, ten days and has new complaint of FBS in OS. CPT code 67820 Epilation takes place same day. How should this claim be submitted? 67820 -79 -LT 67820 -LT Exam -24, 67820 -79 -LT Exam -24 -25, 67820 -79 -LT OK Question Title * 12. When is it appropriate to unbundle CPT codes 15823 Blepharoplasty and 67904 Ptosis repair with modifier -59? When medically indicated Never When different diagnosis codes are used When a functional blepharoplasty is performed on one eye the same time as a functional ptosis repair of the other eye When blepharoplasty is cosmetic and ptosis repair is functional of the same eye OK Question Title * 13. Email for Any Needed Correspondence: OK DONE