Dilation and Irrigation
Nasolacrimal duct obstructions (NLDO) are relatively rare
occurrences in primary eye care practices. In our dry eye clinic we always keep them in the back of our minds as a differential diagnosis for patients who report their main symptom as watering. Additional features that help distinguish an NLDO from more common ocular surface diseases include:
Significant asymmetry in the absence of other asymmetric findings
White, quite eye
Normal tear break up time
Excessive lacrimal lake
No (or very mild) additional symptoms except for chronic watering
The billing challenge for us is that many of these patients have concomitant dry eye.
So the question I always get is: How do I bill for the office visit AND the dilation and irrigation code?
I think the answer is simple, consider the following:
When you evaluate a patient with a watery eye and the primary diagnosis is a nasolacrimal duct obstruction and there was no additional reason for that visit, bill either an office visit code or 68801. No separate reimbursement is made for an eye examination on the same day as any of the dilation & irrigation procedures unless a separately identifiable service is provided and documented.
If there is a separately identifiable service provided on the same day, a (-25) modifier would be applied to the service line associated with the office visit code and that office visit would be linked with your dry eye code. You would also have a 68801 (for dilation and irrigation) that would be linked to the NLDO ICD code.
A clinical example of this would be a patient with ocular surface disease has returned for an evaluation of the dry eye and they also have a newly discovered and reported secondary issue of NLDO, the dry eye is separately assessed and treated under the office visit and the NLDO is assessed and treated with the dilation and irrigation.
Dilation & irrigation has a 10-day global period that begins the day after the surgery. During this period additional follow up visits would be considered to be included in the surgical procedure and will not be paid unless there is a documented reason for the evaluation that is unrelated to the procedure.
If this is the case, a (-24) modifier should be attached to the eye examination code alerting the payer that in this special situation the patient returned in the post operative period for a separate and distinct evaluation that is unrelated to the prior surgery.
Have a great week! - Chris