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Ophthalmology and Optometry Coding Alert

CPT 2003:
Finally, a New Endoscope Code
The CPT Editorial Panel has answered ophthalmology coders' call for a code to ... Read more
Distinguish Eye Codes From E/M Codes
Ophthalmology coders have the luxury of having two sets of code... Read more
FAQs About Eye Codes
The extensive guidelines explaining how to properly use the general ophthalmological... Read more
Please Payers With Proper Low-Vision Therapy Coding
CMS' recent reiteration of the 2000 decision to cover rehabilitation service... Read more
News Brief:
CMS Issues 2003 IOL Implant Reasonable-Charge Instructions
Payments under local carrier jurisdiction for intraocular lenses implanted in a ... Read more
Iron Out Wrinkles in Your Botox-for-Strabismus Coding
The increased use of purified botulinum toxin trade name Botox in ophthlamologic... Read more
Boldly Bill Botox Supplies
With one vial of botulinum toxin costing more than $350 per 100 units and lastin... Read more
Translate Muscular Language Into Strabismus Surgery Codes
Translating the ophthalmologist's documentation into procedure codes is often the ha... Read more
Reader Question:
Diagnosis-Code SBS From Documentation
Question: Our pediatric ophthalmologist was recently called to the ER to con... Read more
Reader Question:
OPT Patients With Signed ABNs Require -GA
Question: Should I use modifier -GA when my ophthalmologist is performing ocul... Read more
Reader Question:
Report Modality for Multiple Retina Repairs
Question: Our ophthalmologist repaired a detached retin... Read more
Reader Question:
Demonstrate Necessity for Adult-Strabismus Payment
Question: Can we get paid for adult-strabismus surgery or is this always considere... Read more
Reader Question:
Dont Use False Diagnosis Codes for Pseudo-Strabismus
Question: Am I just overlooking the pseudo-strabismus diagnosis code or is there not o... Read more
Reader Question:
Check Carrier Policy Before Coding MRIs for Strabismus
Question: When is an MRI covered if the diagnosis is strabismus? Kentucky Subscri... Read more
Reader Question:
Bravely Bill -50 With Bilateral Add-On Codes
Question: If I am coding for strabismus surgery for a patient who had scarring in bo... Read more
Reader Question:
Find the Lost Muscle Code
Question: My ophthalmologist noted a "slipped muscle" in his strabismus surgery ... Read more
Reader Question:
Be Careful Billing Botox and Office Visits
Question: A patient was in the office for Botox injections for strabismus. Can we ... Read more
You Be the Coder:
Modify Multiple Glaucoma Surgery Coding
Test your coding knowledge. Determine how you would code this situation before loo... Read more
You Be the Coder:
Break Down Descriptions to Uncover Transposition Code
Test your coding knowledge. Determine how you would code this situation before looki... Read more
CCI 8.3 Update:
Edits Stress CMS Standard of Care
The latest version of the national Correct Coding Initiative (CCI), valid Oct. 1 to ... Read more
Successfully Bill Consultations in and out of the Office
Although ophthalmologists frequently provide consultations, pro... Read more
CCI 8.3 Bundles Barely Budge Ophthalmology Coding Practice
According to the CCI 8.3 edits, all eye and ocular adnexa procedures in the 60000 seri... Read more
Meet Consultation Requirements With Three Rs
Section 15506 of the Medicare Carriers Manual (MCM) specifies that three guidelines (t... Read more
READER QUESTIONS:
Preseptal Cellulitis
Question: Our physicians saw a patient with an acutely swollen eyelid that prevented h... Read more
READER QUESTIONS:
Re-Repair of Detached Retina
Question: A patient with a detached retina has another detachment during the same glob... Read more
READER QUESTIONS:
Refraction Coding
Question: An established patient came into our office with glaucoma and received evalu... Read more
READER QUESTIONS:
Eye Code Frequency
Question: My ophthalmologist has documented a comprehensive office visit for an establ... Read more
READER QUESTIONS:
Revised Operative Reports
Question: I'm filing a revised operative report. Should I keep the original incorrect ... Read more
You Be the Coder:
Diagnosis Coding Retinopathy
Test your coding knowledge. Determine how you would code this situation before loo... Read more
Correctly Code Glaucoma Surgery As Easy As 1-2-3
If you're not using fifth-digit diagnosis codes to support glaucoma surgery, it sh... Read more
Code Minor Surgery Without Major Confusion
Can't remember whether punctum closure has a 90- or 10-day global period? Don'... Read more
Use Modifier -25 for Office Visits With Chalazion Removal
Correctly determining when modifier -25 (Significant, separately ident... Read more
News Brief:
Use New -KX Modifier for Refractive Lenses
Time is running out: The three-month grace period for implementing modifier -KX (Speci... Read more
Reader Question:
Piggyback Intraocular Lens
Question: I have been receiving denials when I code 66984 and 66985 for a piggyb... Read more
Reader Question:
Botox Injections
Question: What are the codes to bill for Botox injection for a patient diagnosed w... Read more
Reader Question:
New Versus Established Patient
Question: We recently had a patient switch from an HMO to direct Medicare covera... Read more
Reader Question:
Gonioscopy
Question: Our California-based workers' compensation claims for gonioscopy are b... Read more
Reader Question:
Bilateral SCODI
Question: How should we code 92135 when both eyes are done? Does modifier -50 appl... Read more
Reader Question:
Postoperative YAG
Question: Medicare instructed me to use modifier -58 for YAG in the postoperat... Read more
You Be the Coder:
Endothelial Cell Photograph
Test your coding knowledge. Determine how you would code this situation before loo... Read more
Code Epilation for Trichiasis Without Irritation
" Confusion about coding epilation for trichiasis can be a thing of t... Read more
Waive Liability Goodbye With -GA
Learn the rules of the altered -GA modifier (Waiver of liability state... Read more
New Initiative Spotlights Diabetic Eye Screening
Heads up, ophthalmology coders: It's time to brush up on the rules for coding diabet... Read more
Diagnose Diabetic Screenings Diligently
When you are diagnosing a diabetic patient, the first rule of thumb is to use the di... Read more
Reader Question:
Discontinued Procedure
Question: A patient presented with difficulty seeing the television, and our physici... Read more
Reader Question:
Discontinued Laser Treatment
Question: One of our physicians was performing a laser treatment on a patient's reti... Read more
Reader Question:
Diagnosing Macula Edema
Question: My physician often uses "macula edema" as his only diagnosis documentation... Read more
You Be the Coder:
Nasolacrimal Duct Obstruction
Test your coding knowledge. Determine how you would code this situation before looki... Read more
Find Your Way to Foolproof Fundus Photography Reimbursements
How you handle fundus photography claims today could affect the outcome of your n... Read more
CCI Edits 8.2 Clear Up Cloudy Cataract Coding
Coders have been back and forth over the rules for billing iridectomies, trabeculectom... Read more
CCI 8.2 Update:
Dont Come Apart Over Abundant Bundling
The Correct Coding Initiative 8.2 edits have arrived, and while the number of new bu... Read more
Simplifying Complex Cataract Coding Is Worthwhile
When CMS recognized the new CPT code for complex cataract surgery, 66982, its intentio... Read more
Late-Breaking News:
AAO Challenges BCBS SCODI Policy
The American Academy of Ophthalmology has finally confronted Blue Cross and Blue Shiel... Read more
CMS Sees to Establishing Low-Vision National Coverage
The Centers for Medicare and Medicaid Services (CMS) announced May 29 that physician-p... Read more
AAO Pressures CMS for E/M Decisions
The AAO, supported by the American Medical Association, urged CMS on May 17 to re-eval... Read more
Reader Question:
Follow-Up Surgery
Question: Our physician often injects 5FU following a trabeculectomy. How can I code t... Read more
Reader Question:
Laser Suture Removal
Question: One of our physicians recently performed a suture removal following a trab... Read more
Reader Question:
Endoscopic Cilliary Photocoagulation
Question: My physician is planning to perform endoscopic cilliary photocoagulation, ... Read more
Reader Question:
Postoperative Suture
Question: A patient presented with an open wound that our physician prepped and suture... Read more
You Be the Coder:
Ocular Photodynamic Therapy
Test your coding knowledge. Determine how you would code this situation before looking a... Read more
Use Eye Modifiers to See Your Way Past Global Period Coding Problems
" The eye modifiers (-LT, Left side; and -RT, Right side) can be the key t... Read more
Cataract Extraction:
LMRP Includes Secondary Diagnosis Code List for 66982
AdminaStar Federal, the Medicare Part B carrier for Indiana and Kentucky, has issued... Read more
News Brief:
Aetna Issues Low-Vision Coverage Policy
Aetna U.S. Healthcare now covers low-vision programs for patients who meet the criteri... Read more
Correction
The June 2002 Ophthalmology Coding Alert article "Use Eyelid Modifiers (-E1, -E2, -E3,... Read more
Reader Question:
Corneal Foreign-Body Removal
Question: How should we code a corneal foreign-body removal? Can we charge for an of... Read more
Reader Question:
Dislocated Intraocular Lens
Question: How should we code for the removal of a dislocated intraocular lens (IOL), rem... Read more
Reader Question:
Billing for Osmoglyn
Question: We recently had patients with severe elevated pressure. The ophthalmologist ... Read more
Reader Question:
Mitomycin-C
Question: What is the code for mitomycin-C? The ophthalmologist used it to maintain the ... Read more
Reader Question:
Trabeculoplasty
Question: What is the postoperative period for trabeculoplasty? Ohio Subscriber Answ... Read more
Reader Question:
Bilateral Lacrimal Probing
Question: How should I bill lacrimal probing when performed bilaterally? North Carolina... Read more
Reader Question:
Cataract Extraction and Pterygium
Question: We performed a cataract extraction and a pterygium in the same session and b... Read more
You Be the Coder:
Bilateral Punctal Eversion
Test your coding knowledge. Determine how you would code this situation before looking a... Read more
Use Eyelid Modifiers (-E1, -E2, -E3, -E4) for Three Procedures
Reviewed on May 18, 2015 Coders are often confused about when to use the eyelid modifier... Read more
Coordinate Co-Management Care With Modifiers -54 and -55
Ophthalmologists and optometrists often work together caring for cataract surgery pati... Read more
News Brief:
CMS Announces OPT Not Covered for Occult Lesions
On March 28, 2002, CMS announced that ophthalmologists cannot use 67221 (Destructi... Read more
Exercise Caution When Billing Scanning Laser With Visual Fields
When you examine a glaucoma patient, some carriers limit additional diagnost... Read more
Reader Question:
Bilateral GDX
Question: How should we bill for GDX testing when performed bilaterally? Ohio Subsc... Read more
Reader Question:
Prosthesis Implantation
Question: Our physician inserted a retinal prosthesis. How should I code this pro... Read more
Reader Question:
Multiple Xanthelasma Removal
Question: Our physician removed xanthelasma from all four lids. There was extensive mu... Read more
Reader Question:
Diagnosis for New Eyeglasses
Question: When we prescribe new eyeglasses only, should we use a diagnosis of 368.8? W... Read more
Reader Question:
Postsurgery Astigmatism
Question: How should I code surgically induced astigmatism? California Subscriber An... Read more
Reader Question:
Office Visit and Refraction
Question: A Medicare patient comes in for a medical examination, and we also perform a... Read more
Reader Question:
No Foreign Body
Question: Which diagnosis code should we use when a patient comes in with a foreign-bo... Read more
Reader Question:
Levator Resection
Question: What is the code for a levator resection? New Jersey Subscriber Answer: Fo... Read more
You Be the Coder:
IOL Placement
Test your coding knowledge. Determine how you would code this situation before looking... Read more
How to Handle Double-Billing with Workers Compensation Cases
Eye injuries sustained on the job may require the ophthalmologist to bill a workers' c... Read more
CCI 8.1 Update:
Most New Edits Allow Unbundling with Modifier -59
The Correct Coding Initiative (CCI) version 8.1, effective April 1 to June 3... Read more
Dont Let Blurred Vision Stop You from Seeing 368.8 Clearly
Often a patient with only a complaint of blurry vision will visit an ophthalmologist. ... Read more
Reader Question:
Aphakia Lenses
Question: What is the correct way to code for aphakia lenses? We have been receiving d... Read more
Reader Question:
Refraction without New Prescription
Question: Should I code for a refraction if a new prescription is not required? Flor... Read more
Reader Question:
Defining a Refraction
Question: What is a refraction? Isn't it part of every eye exam? Florida Subscriber... Read more
Reader Question:
Goniopuncture
Question: What is the code for "goniopuncture"? Illinois Subscriber Answer: There is... Read more
Reader Question:
Optometrist Referral
Question: Can we bill a consultation based on a referral from an optometrist? Califor... Read more
Reader Question:
Postsurgery Gonioscopy
Question: Should I bill for gonioscopy during the postoperative period of cataract s... Read more
Reader Question:
Corneal Scrapings
Question: Should I bill for corneal scrapings (65430) for each ulcer? Ohio Subscriber ... Read more
Reader Question:
Oculoplastics
Question: Many of the oculoplastic procedures I perform have no CPT code, or have am... Read more
You Be the Coder:
Plug Reinsertion
Test your coding knowledge. Determine how you would code this situation before looking... Read more
Know When to Use Glaucoma Screening Codes versus E/M or Eye Codes
" Ophthalmologists initially welcomed Medicare's decision to cover glaucoma screening effe... Read more
Choose between Consultation, New Patient and Eye Codes
CMS Transmittal 1644, issued in August 1999, revised Section 15506 of the Medicare Car... Read more
News Brief:
Medicare Reimbursement Drops for Punctal Plug Procedures
Reimbursement for three punctal plug procedures (68761, Closure of the lacrimal punctum;... Read more
News Brief:
Delete Q3013 from Your HCPCS Books
The AMA on Feb. 4, 2002, issued corrections to HCPCS 2002 including the deletion of Q3013 ... Read more
Reader Question:
Glaucoma Checkup
Question: Which code should I use for follow-up on a glaucoma patient who is well contro... Read more
Reader Question:
Brow Ptosis
Question: What is the best code combination for brow ptosis repair?Florida Subscriber &nb... Read more
Reader Question:
Postsurgery Injection
Question: A patient had repositioning of the iris and intraocular lens (IOL) and a revisio... Read more
Reader Question:
Graft with Shunt
Question: Which CPT code should we use for a scleral patch graft following aqueous shunt p... Read more
You Be the Coder:
IOL Master versus A-Scan
Test your coding knowledge.  Determine how you would code this situation before loo... Read more
Report Multiple Retinopathy Treatments Based on Location, Type, Time
Patients with diabetic retinopathy (DR) may require a series of laser treatments, pred... Read more
Document Medical Necessity to Bill Angiography Bilaterally
Angiography can be performed on one or both eyes. Whether it can be coded bilater... Read more
Reader Question:
Visual Fields: Interpretation and Test
Question: How should I bill for an interpretation of visual fields and performing the pr... Read more
Reader Question:
Billing for LASIK
Question: For laser-assisted in situ keratomileusis (LASIK) surgery, should we use 65760 o... Read more
Reader Question:
Dx for Benign Lesion
Question: Which diagnosis codes should I use for removal of a benign lesion?California Sub... Read more
Reader Question:
Postsurgery CME
Question: Why am I not receiving payment for treating cystoid macular edema (CME) after ... Read more
Reader Question:
Time-Consuming DCR
Question: How can we receive ethical reimbursement for a (dacryocystorhinostomy)DCR ... Read more
Reader Question:
Blepharoplasty and Blepharoptosis
Question: Are blepharoplasty (15823) and repair of blepharoptosis (67908) bundled?Californ... Read more
Reader Question:
Same-Day Preoperative and A-Scan
Question: A patient had a laser treatment. He returned for a follow-up visit a week late... Read more
You Be the Coder:
Dx for Disappearing Crossed Eyes
Test your coding knowledge.  Determine how you would code this situation before loo... Read more
Master Muscle Anatomy to Properly Report Multiple Strabismus Surgery
Coding strabismus surgery requires understanding the muscle anatomy. In each eye, ther... Read more
Plan Coding for Cataract Evaluation in Second Eye
When evaluating a patient who had cataract surgery in one eye, code the visit for the ... Read more
Conduct Strong Interview to Identify Complaint, Diagnosis
Selecting the correct diagnosis code or codes to link to a procedure depends partly on... Read more
News Brief:
CCI 8.0 Includes Eyelid Reconstruction, Screening
Version 8.0 of the Correct Coding Initiative (CCI), effective Jan. 1, 2002, includes ... Read more
News Brief:
Fee Schedule: More Money for Services, Less for Surgery
The four-year phase-in period for practice-expense relative value units has ended, and o... Read more
Correction:
Modifier -GA Is for an ABN
 An astute reader noticed that in the January issue of Ophthalmology Coding Alert the... Read more
Reader Question:
Gold Weight Implants
Question: Which CPT code should I use for eyelid gold weight implantation?Texas Subscriber... Read more
Reader Question:
Suture Removal
Question: Another ophthalmologist performed a repair, and the patient came to us to have t... Read more
Reader Question:
Blood Flow Analyzer
Question: Which code should I use for the blood flow analyzer?California Subscriber A... Read more
Reader Question:
Office Visit Limits
Question: Are there limits on how often I should use office visit codes for my patients?... Read more
You Be the Coder:
Dx for Brow Ptosis
Test your coding knowledge.  Determine how you would code this situation before l... Read more
Use Different Diagnosis When Billing for an Office Visit and Minor Surgery
When the diagnosis is the same or similar for an office visit and minor surgery, ... Read more
Choose Modifiers -58, -78, -79 for Re-Repair of Detached Retina
Re-repairs are uncommon, but they happen. Candidates often have a detached retina (67107... Read more
News Brief:
Good News and Bad News in Medicare Fee Schedule
The Medicare Fee Schedule for 2002, with its reduced conversion factor, will lower pa... Read more
Free Anthrax Coding Report on Web
Physicians and other healthcare professionals who provide services to any patients with ac... Read more
CMS Downgrades A- and B-Scan Supervision Requirements
Ophthalmologists can now leave more tests to their technicians, freeing up their time ... Read more
News Brief:
Visudyne for Occult ARMD Not yet Covered
Now that coding and payment policies for ocular photodynamic therapy (OPT) (67221, destruc... Read more
Reader Question:
Modifier -GX Replacements
Question: I heard that modifier -GX is being replaced. What should I use instead?Ohio ... Read more
Reader Question:
Snipping a Conjunctival Cyst
Question: A doctor removed a conjunctival cyst, but did not incise or drain it, only snipp... Read more
Reader Question:
Dx for Irritated Pinguecula
Question: Which diagnosis code should I use for an irritated pinguecula?Connecticut Subscr... Read more
You Be the Coder:
Is Refraction for Medicare Patient
Test your coding knowledge.  Determine how you would code this situation before l... Read more
Available Years:  2002  2001  2000  1999  1998