​How To Properly Bill Punctal Plugs

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Punctal plugs are very useful in treating dry eye. The procedure will decrease the rate of clearance of the natural tears on the ocular surface. I typically consider placing plugs (lower plugs first, then the upper plugs, if needed at another exam and medically warranted) once the inflammation has been controlled (treatment with Restasis, Xiidra, steroids for 3 months) and you have healthier tears to keep on the ocular surface for a longer time.


Surgical Procedure
Punctal plugs are a surgical procedure and you need to document previous treatments you have tried. Punctal plugs should not be considered as a primary treatment option for dry eye and you need to make sure this procedure is billed properly. The summary below highlights the key points.


Dry Eye Codes Recognized in ICD 10

Names

Codes

Keratoconjunctivitis sicca, not specified as Sjogren's

H16.22-

Dry eye syndrome


H04.12-


Exposure Keratoconjunctivitis


H16.21-

Sicca Syndrome (Sjogren's syndrome)


M35.0


Stenosis of lacrimal punctum


H04.56-

Conjunctival Xerosis

H11.14-



CPT Codes


CPT Codes for Punctal Plugs


68761- Closure of lacrimal punctum; by plug, each

Locations – E Modifiers

E1- Left upper lid

E2- Left lower lid

E3- Right upper lid

E4- Right lower lid

RT- Right LT- Left

25 Modifier


Used to bill plugs and an exam in the same visit (a separate and identifiable reason for the visit)

51 Modifier


Multiple plugs placed at the same visit

Global period


10 days


Key Points
When billing an exam and a procedure in the same day, the chief complaint must be related to the primary ICD 10 diagnosis code (not a dry eye code) and a secondary ICD dry eye diagnosis code is linked to the procedure and the 25 modifier.

Questions?
Email us today! We can help.


--Josh Johnston, O.D., F.A.A.O.
www.oculusocp.com

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