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Ophthalmology and Optometry Coding Alert

Visual Fields:
Clarify Your VF Coding for Glaucoma Suspects
Follow these three tips for solid 92081-92083 claims. Ophthalmologists usually spend a... Read more
HIPAA:
Solidify Your HIPAA Policies and Practices Before the Auditors Come Knocking
All covered entities and business associates are on the audit list, HHS says. HIPAA is... Read more
ICD-10 Update:
Don't Get Sidelined By These 3 ICD-10 Myths
Don’t assume that ICD-10 will allow you to use the same code twice. With the hea... Read more
Compliance:
Bust These 5 Common Compliance Myths
Tip: Make a good faith effort to comply with the spirit of the law. Don’t get wa... Read more
Reader Question:
Specify Refraction Exclusion to Clarify ABN Confusion
Question: Are patients undergoing keratoconus workup or contact lens fitting still requi... Read more
Reader Question:
MSP Doesn't Change Medicare Consultation Pay
Question: I know Medicare doesn’t reimburse consults anymore, but a new coder we h... Read more
You Be the Coder:
Cataract Removal With Pupil Stretching
Question: Our ophthalmologist wants me to submit a claim for 66982, along with stretchin... Read more
CCI Update:
CCI Suspends Edits Bundling 92012, 92014 Into Hundreds of Procedures
Claims processing problem prevented modifier 25 from unbundling procedures, CMS says E... Read more
Government Shutdown:
Medicare Keeps Rolling Despite Shutdown
Your MACs will continue processing payments, enrollment, CMS says. Whether you were wo... Read more
Advance Beneficiary Notices:
Adding 'G' Modifiers on Your Medicare Claims? Expect Extra Scrutiny
The OIG report puts GA, GZ, GY, and GX in the hot seat. When your practice is billing ... Read more
Incident-to Billing:
Adding NPP Can Boost Productivity and Income -- But Know the Risks
Be sure you consult your state laws and NPP scope of practice rules before hiring. Hir... Read more
Compliance:
E/M Errors Top Medicare's List of Improperly Billed Codes in 2012
CERT results reveal $29.6 billion in improper Medicare payments — $1.1 billion of ... Read more
Reader Question:
Avoid 67210 for Repeat Focal Laser
Question: A patient returns during the 90-day postoperative period of a focal laser... Read more
Reader Question:
Get Patient Okay Before Disclosing PHI
Question: Who’s authorized to make a request to review a patient’s medi... Read more
You Be the Coder:
Pars Plana Vitrectomy
Question: Our ophthalmologist performed a pars plana vitrectomy, removing lens frag... Read more
Pre-Cataract Surgery Tests:
76519, 92136: Understand Bilateral Rules and Receive Fair Reimbursement
Check out these common IOL power calculation myths — is one of them tripping up yo... Read more
Associated Diagnoses
Medicare covers IOL calculation procedures for patients about to undergo cataract surger... Read more
ICD-10:
Conversion to ICD-10 Won't Be A Huge Financial Burden, CMS Reps Say
Plus: ICD-10 claims will allow you to submit the letters as either upper or lowercase, C... Read more
Practice Management:
Breeze Through HIPAA Audit With 5 Protocol Tips
Try your hand at internal audits first. Random and targeted HIPAA audits are making th... Read more
Reader Question:
Angle Kappa Measurement Is Incidental
Question: We perform a measurement called angle kappa to help in calculating and choosin... Read more
Reader Question:
76514 Suffices for Bilateral Pachymetry
Question: I’m trying to submit a claim for 76514 performed on both eyes, but I&rsq... Read more
Reader Question:
379.31 Proves Necessity for V2219
Question: I’m really confused about codes V2219 and V2319 for Medicare patients. I... Read more
You Be the Coder:
Post-Op Exam With Unrelated Complaint
Question: We did a general eye exam at the patient’s request within the three-mont... Read more
Ophthalmic Trauma Care:
Know FBR, Laceration Repair Codes and Avoid Claims Emergencies
Tip: Coding depends on location of the ocular foreign body. Treating ophthalmic emerge... Read more
Part B Payment:
Proposed 2014 Fee Schedule Suggests Steep Cuts
But in 2015, practitioners could finally see bonuses for non-face-to-face services admin... Read more
ICD-10 Prep:
Let 4 FAQs Help Guide Your ICD-10 Focus
Don’t limit your training to code selection alone. The ICD-10 implementation de... Read more
Reader Question:
Same Day, Different Procedure Visits
Question:  A patient pays a visit to the clinic for a routine eye exam in the morni... Read more
Reader Question:
Mitigate Late Patient Costs With Block Scheduling
Question:  Recently we have had a lot of patients showing up late for appointments.... Read more
You Be the Coder:
Refraction Services
Question: For refraction, should I report a 992xx or 92xxx exam code? Maine Subscrib... Read more
CCI 19.2:
Edits Direct You to Steer Clear of Reporting E/M With Many Procedure
CCI implements bundles for ophthalmological procedures already covered by global period ... Read more
Strabismus:
With Almost $190 at Stake, Don't Miss This Bilateral Strabismus Coding Advice
Check the Medicare fee schedule for important bilateral coding guidelines for 673xx. C... Read more
E/M Coding:
Take Steps to MDM Determination Success -- Every Time
This system will help you correctly calculate each piece of the MDM puzzle. Are you in... Read more
Reader Question:
Brush Up on ICD-10 Differences
Question: I’ve seen lots of specific examples of ICD-10 codes, but I think it woul... Read more
Reader Question:
92015-92140 and 92002-92014 Can Mix
Question: Can the special ophthalmological services be provided and reported with the ge... Read more
Reader Question:
64612 Describes Botox-Induced Tarsorrhaphy
Question: We have a patient with a corneal ulcer and herpes zoster. To help the healing ... Read more
Reader Question:
67210 and 67228 Cover 2 Photocoagulation Sessions Within 1 Global
Question: A patient presented with background diabetic retinopathy and retinal edema in ... Read more
You Be the Coder:
Epilation of Lashes
Question: What is the proper way to code for epilation of lashes? We used to bill per la... Read more
AMD:
3 Tips Lead to Foolproof Coding for Macular Degeneration Cases
Hint: Check bilateral status before coding. Nearly 2 million Americans have age-relate... Read more
FBR:
Don't Be Blind to 3 Factors When Coding Ocular Foreign Body Removals
Look closely at the documentation for these clues to determine the right code assignment... Read more
Part B Mythbuster:
Check Out These Top 5 ABN Myths
These surprising CMS rules on ABN use are straight from Medicare policy. You’ve ... Read more
Medicare:
CMS Clarifies 2 Hot Issues
From bilateral billing to signature regs, CMS was busy working on May policy adjustments... Read more
Reader Question:
Focal Argon Laser for Von Hipple Aneurysms
Question: Can you help me code this scenario? The patient had a recurrent problem with V... Read more
Reader Question:
Amend Documentation With Care
Question: One of our ophthalmologists wants to amend documentation of a procedure, but w... Read more
You Be the Coder:
EO for Flashes and Floaters
Question: A patient reports flashes and floaters but the ophthalmologist does not find e... Read more
Cataract Surgery:
3 Scenarios Help Focus Your Cataract Coding
Tip: You can code vitrectomies separately — sometimes. With several possible sur... Read more
Gonioscopy:
92020 FAQ: Watch Bilateral Status, Diagnoses for Gonioscopy
There may only be one gonioscopy code, but there are several ways you can sabotage your ... Read more
Billing:
3 Tips Clean Up Your Incident-To Billing
Steer clear of 2013 OIG Work Plan scrutiny. If your ophthalmology practice utilizes no... Read more
Reader Question:
Code Only Finished Procedure in Abandoned Photocoagulation
Question: After discussing the risks and benefits of both cryotherapy and photocoagulati... Read more
Reader Question:
Wait Until Oct. 1, 2014, to Use ICD-10
Question: Our practice is considering submitting claims with ICD-10 codes before the imp... Read more
Reader Question:
375.15 and 370.21 Are Distinguishable by Condition
Question: Can 375.15 and 370.21 be used interchangeably? When would one be the preferred... Read more
You Be the Coder:
Bleb Needling
Question:  My ophthalmologist performed a needling procedure during the postoperati... Read more
CCI Update:
Include Lens Fitting In These Cornea Codes
Know when you can — and can’t — split bundles. When certain procedur... Read more
ICD-9 Coding:
Vague Complaints Don't Have to Mean Vague Coding
Tip: Find the cause of these nonspecific complaints to arrive at the correct diagnosis c... Read more
Cash Flow:
5 Hidden Income Opportunities Ease the Pain of Sequestration Cuts
Your Medicare pay was slashed by 2 percent on April 1 — these tips will help bring... Read more
Reader Question:
Try 67036 for Posterior Segment Vitrectomy
Question: Our ophthalmologist performed a pars plana vitrectomy, removing lens frag... Read more
Reader Question:
Make Arrangements for Incident-To Under Locum Tenens
Question: One of the ophthalmologists in our practice will be traveling for two months a... Read more
Reader Question:
Let Medical Necessity Rule Code Choice
Question: Our ophthalmologist is a very thorough documenter and treats very sick patient... Read more
Reader Question:
Keep a Record of Your Provider's Signature Variations
Question: We’re having trouble making sure our providers meet signature requiremen... Read more
You Be the Coder:
Trabeculectomy Suture Removal
Question: I am trying to bill for the removal of sutures the ophthalmologist placed duri... Read more
Blepharoplasty:
Show Bleph Procedures Aren't Always Cosmetic
Are you missing out on deserved reimbursement for 15820-15823? Many ophthalmologists a... Read more
Code Only Once for 2 Visual Field Tests
Because your ophthalmologist performs the VF testing twice, you may be tempted to code t... Read more
Eyelid Procedures:
67840, 11440-11446, 11640-11646? Find the Right Lesion Removal Code or Risk $116
Tip: If the surgery involves more than the eyelid’s skin, turn to 67840. When yo... Read more
News You Can Use:
You're Saved From 26.5 Percent Physician Pay Cut
But RVU changes still in effect. Ophthalmologists can expect a reprieve from the dread... Read more
Consolidated Billing:
Follow 3 Tips to Ensure You Properly Bill Services for Nursing Facility Patients
Don’t wait to check the patient’s status until you are ready to file a claim... Read more
Reader Question:
Unilateral 92133
Question: We performed an OCT on a patient’s left eye, and filed the claim with 92... Read more
Reader Question:
365.01 Describes Dx for Normal VF
Question: We had a patient present with high intraocular pressure, a sign of glaucoma, a... Read more
You Be the Coder:
Untangle This Vision Loss Scenario
Question: For a recent visit, the ophthalmologist’s notes read: Procedure: Exa... Read more
Diagnostic Tests:
92225-92226 Coding: Get to Know These Guidelines for Extended Ophthalmoscopy
With $27 on the line each time, staying on top of carrier rules is critical. Many oph... Read more
Practice Management:
Get Ready For OIG Scrutiny of Modifiers and More
Audit yourself before the feds come calling. Your ophthalmology practice could come un... Read more
Visual Fields:
Don't Pick Intermediate VF Code When Extended Code Is Justified
Choosing between 92082 or 92083 can be tricky -- let our expert advice guide you. ... Read more
E/M Coding:
Implement These 5 Simple Steps to Boost Your E/M Bottom Line
Heads up: Dig past ‘follow-up’ for acceptable chief complaint. E/M coding ... Read more
Reader Question:
List Referring Doctor's Name for Pachymetry
Question:  I am billing pachymetry (76514, 1 unit) with a diagnosis code of 365.04 ... Read more
Reader Question:
Code Finished, Not Abandoned, Photocoagulation Procedure
Question:  After discussing the risks and benefits of both cryotherapy and photocoa... Read more
Reader Question:
No New Code Describes Paperwork
Question: I’ve heard that CPT® has a new code for reviewing records separate f... Read more
Reader Question:
Inform Patients Before Collecting Co-Pays Up Front
Question: One of our providers returned from a meeting, saying he had talked to other pr... Read more
You Be the Coder:
Dx for Post-LASIK Cataracts
Question: A patient who has had LASIK surgery now has cataracts. One of our ophthalmolog... Read more
CCI 19.0 Update:
0308T Bundles: Temporary Ocular Telescope Code Included in Dozens of Eye Codes
Watch for documentation of medical necessity to break bundles. Ophthalmic surgeons in ... Read more
EHR:
Does Your Electronic Prescription System Pass Muster?
Get started now to avoid further pay hits in 2014. Incentives for using electronic pre... Read more
Documentation:
Avoid Billing E/M Service Based on Cloned Documentation, Or the OIG Will Come Knocking
Ensure your EMR is not setting you up for failure. If you have reviewed the HHS Offic... Read more
Reader Question:
66170 Includes Trabeculectomy Suture Removal
Question: I am trying to bill for the removal of sutures the ophthalmologist placed duri... Read more
Reader Question:
No Code for Slit-Lamp-Only Exam
Question: One of our ophthalmologists uses a slit-lamp to check on healing after a forei... Read more
Reader Question:
Legibility Matters, CMS Stresses
Question: I have heard payers are cracking down on illegible provider documentation. My ... Read more
Reader Question:
Know When to Bill Secondary Payer
Question:  We have many patients with secondary insurance, some of which have deduc... Read more
You Be the Coder:
Damaged Ducts
Question: I am having trouble finding the proper diagnosis code for this claim. The opht... Read more
Retina Treatments:
Seal Off Coding Errors for Leak-Proof Diabetic Retinopathy Coding
$1500 may be at stake for your practice if you report 67210 or 67228 incorrectly. In r... Read more
Modifiers:
Understand Eyelid Modifiers and Avoid Coding Confusion
Do you need E1-E4 for punctal plugs and epilation? Thanks to the abundance of bilatera... Read more
CCI:
Modifiers 24 and 57 Will Soon Allow You to Bypass CCI Edits
Plus: You can also override bundles with modifiers LM and RI We’ve all heard the... Read more
Compliance:
Watch for Extra Scrutiny of Your Ophthalmological Services
Incident-to billing, E/M coding, and more are on the OIG watch list in 2013. If you a... Read more
ICD-10:
Your ICD-10 Transition Plan Should Encompass 6 Phases, Expert Says
A working budget should include every aspect of planning, including productivity trainin... Read more
Reader Question:
92020, 92285 Tell Slit Lamp With Gonioscopy Story
Question: Our ophthalmologist saw a glaucoma patient and performed a gonioscopy. The oph... Read more
Reader Question:
92133 or 92134 Answers Nonconclusive HRT Question
Question: How should I code for a nonconclusive HRT? One of our patients had one done, b... Read more
Reader Question:
92240 Includes ICG Dye
Question: One of our physicians wants to know if we can bill for indocyanine-green dye. ... Read more
You Be the Coder:
False Esotropia
Question: What ICD-9 code should I report for a diagnosis of pseudostrabismus? Califor... Read more
Available Years:  2013  2012  2011  2010  2009  2008  2007  2006  2005  2004  2003  2002  2001  2000  1999  1998