tci Part B Insider - 2006 Issue 8

OPTOMETRY: Plug In To These Punctum Plug Reimbursement Rules--Or Pay The Price

Report 68761 using E1-E4When it comes to punctum plugs or punctum closures, keep your eyes on the prize by showing the procedures are medically necessary. Here's how.Most Medicare carriers want you to report code 68761 (Closure of the lacrimal punctum; by plug, each) once per eyelid, using E1-E4, says Kristen Keller, billing manager at Five Points Eye Care in Athens, GA. But if you insert more than two plugs, be prepared to justify the medical necessity.Medicare feels that "[i]n most cases of dry-eye syndrome requiring punctum plugs or punctum closure, placement of one plug in (or closure...

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