Ophthalmology and Optometry Coding Alert
CPT® 2021:
Look Forward to New Retinal Imaging Code in January
Plus: You'll find revisions to other eye imaging codes in 2021. As eye care practices pre... Read more
Look Forward to New Retinal Imaging Code in January
Plus: You'll find revisions to other eye imaging codes in 2021. As eye care practices pre... Read more
ICD-10 Coding:
Can You Pinpoint These Eye Care Diagnosis Codes?
Hint: Not all cataracts are age-related. The calendar is about to turn to a new year, but... Read more
Can You Pinpoint These Eye Care Diagnosis Codes?
Hint: Not all cataracts are age-related. The calendar is about to turn to a new year, but... Read more
Modifiers:
12 Tips Lead You to Modifier Coding Bliss
Hint: Avoid appending modifier 51 — instead, let the payers do that. Eye care practic... Read more
12 Tips Lead You to Modifier Coding Bliss
Hint: Avoid appending modifier 51 — instead, let the payers do that. Eye care practic... Read more
You Be the Coder:
Can You Report Standalone Code for Femtosecond Laser?
Question: Our physician recently started using a femtosecond laser during keratoplasty. Wh... Read more
Can You Report Standalone Code for Femtosecond Laser?
Question: Our physician recently started using a femtosecond laser during keratoplasty. Wh... Read more
Reader Question:
Get Specific for Hypotony Diagnosis
Question: A 33-year-old patient presented to our office with hypotony. Which is the right ... Read more
Get Specific for Hypotony Diagnosis
Question: A 33-year-old patient presented to our office with hypotony. Which is the right ... Read more
Reader Questions:
Don’t Look for ‘Admit’ Code
Question: Our ophthalmologist often does rounds at the hospital but rarely admits patients... Read more
Don’t Look for ‘Admit’ Code
Question: Our ophthalmologist often does rounds at the hospital but rarely admits patients... Read more
Reader Questions:
PHI Goes Beyond Patient’s Medical Record
Question: Is there more to protected health information (PHI) than just a patient's medica... Read more
PHI Goes Beyond Patient’s Medical Record
Question: Is there more to protected health information (PHI) than just a patient's medica... Read more
Compliance:
Report Lucentis Accurately to Avoid This Ophthalmologist’s Fate
Remember: Single-use vials are meant to be billed only for one patient. Billing payers fo... Read more
Report Lucentis Accurately to Avoid This Ophthalmologist’s Fate
Remember: Single-use vials are meant to be billed only for one patient. Billing payers fo... Read more
Documentation:
Shore Up Your Documentation Skills With These Eye Care-Focused Examples
Do you know what's necessary for cataract, blepharoplasty best practices? Although coding... Read more
Shore Up Your Documentation Skills With These Eye Care-Focused Examples
Do you know what's necessary for cataract, blepharoplasty best practices? Although coding... Read more
2021 E/M Coding:
Check Your 2021 E/M Coding Skills
Get the lowdown now on how E/M coding will change in January. Eye care practitioners have... Read more
Check Your 2021 E/M Coding Skills
Get the lowdown now on how E/M coding will change in January. Eye care practitioners have... Read more
You Be the Coder:
Pinpoint Glaucoma Diagnoses
Question: Thank you for your article about glaucoma screenings – we read it and had a fo... Read more
Pinpoint Glaucoma Diagnoses
Question: Thank you for your article about glaucoma screenings – we read it and had a fo... Read more
Reader Questions:
Get a Handle on Multiple Modifier Rules
Question: What are the rules governing multiple modifier sequencing? Massachusetts Subsc... Read more
Get a Handle on Multiple Modifier Rules
Question: What are the rules governing multiple modifier sequencing? Massachusetts Subsc... Read more
Reader Questions:
Determine How to Report Split/Shared Visits
Question: Can qualified advanced practice providers (APPs) “split” a service with a ph... Read more
Determine How to Report Split/Shared Visits
Question: Can qualified advanced practice providers (APPs) “split” a service with a ph... Read more
Reader Questions:
Keratoconus Can Unlock Contact Lens Pay
Question: We know we can't bill Medicare for regular refractive contact lenses, but how ca... Read more
Keratoconus Can Unlock Contact Lens Pay
Question: We know we can't bill Medicare for regular refractive contact lenses, but how ca... Read more
Reader Questions:
Yes, You Can Bill Inpatient Visits Based on Time
Question: Our ophthalmologist saw a patient who had been in a car accident and suffered mu... Read more
Yes, You Can Bill Inpatient Visits Based on Time
Question: Our ophthalmologist saw a patient who had been in a car accident and suffered mu... Read more
Glaucoma Screening:
Medicare Reps Shed Light on 10 Facts About Glaucoma Screening
Hint: Check the NCCI edits before you report these services along with an E/M code. Glauc... Read more
Medicare Reps Shed Light on 10 Facts About Glaucoma Screening
Hint: Check the NCCI edits before you report these services along with an E/M code. Glauc... Read more
E/M Visits:
Check These Key Factors to Ace E/M Coding in 2021
Hint: You'll need to be able to define the word “stable” next year. As your eye care... Read more
Check These Key Factors to Ace E/M Coding in 2021
Hint: You'll need to be able to define the word “stable” next year. As your eye care... Read more
Reimbursement:
Eye Care Practices Could See Steep Cuts if CMS’ Proposal Is Finalized
Plus: Telehealth may expand into next year. In addition to the E/M code changes on the ag... Read more
Eye Care Practices Could See Steep Cuts if CMS’ Proposal Is Finalized
Plus: Telehealth may expand into next year. In addition to the E/M code changes on the ag... Read more
You Be the Coder:
Should You Use Bilateral Modifiers With 92134?
Question: We performed SCODI on both of a patient's eyes and used modifiers LT (Left side)... Read more
Should You Use Bilateral Modifiers With 92134?
Question: We performed SCODI on both of a patient's eyes and used modifiers LT (Left side)... Read more
Reader Questions:
Get to Know the Cataract Excision Rules
Question: We had a patient present complaining of cataracts. The physician told the patie... Read more
Get to Know the Cataract Excision Rules
Question: We had a patient present complaining of cataracts. The physician told the patie... Read more
Reader Questions:
Check What Constitutes Nurse Visits
Question: An established patient visited our office to receive an injection. The nurse adm... Read more
Check What Constitutes Nurse Visits
Question: An established patient visited our office to receive an injection. The nurse adm... Read more
Reader Question:
Get to Know ‘Aura’ Specifics
Question: We saw a patient for a migraine recently and she was seeing flashes during it. D... Read more
Get to Know ‘Aura’ Specifics
Question: We saw a patient for a migraine recently and she was seeing flashes during it. D... Read more
Vision Benefits:
Clarify Vision Benefits to Ensure Maximum Returns
Contacts vs. glasses? The vision plan may not cover both. A vision plan is different from... Read more
Clarify Vision Benefits to Ensure Maximum Returns
Contacts vs. glasses? The vision plan may not cover both. A vision plan is different from... Read more
Surgical Coding:
3 Steps Help You Code Repeat Retinal Repairs With Ease
Hint: 67108 should never be a catch-all code. Most eye care physicians would agree that... Read more
3 Steps Help You Code Repeat Retinal Repairs With Ease
Hint: 67108 should never be a catch-all code. Most eye care physicians would agree that... Read more
Compliance:
Shore up Your Telehealth Documentation to Avoid Audit Mishaps
Reviews are on the way for telehealth services you provided during the PHE. When the gove... Read more
Shore up Your Telehealth Documentation to Avoid Audit Mishaps
Reviews are on the way for telehealth services you provided during the PHE. When the gove... Read more
Don't Forget to Include These Factors in Your Telehealth Documentation
Every practice should ensure that their telehealth and phone visits stack up against provi... Read more
Every practice should ensure that their telehealth and phone visits stack up against provi... Read more
Reader Questions:
Watch for Updated ABN
Question: We were told to use a new ABN form but we aren't sure if we have it or if we nee... Read more
Watch for Updated ABN
Question: We were told to use a new ABN form but we aren't sure if we have it or if we nee... Read more
Reader Questions:
Get to Know Coding Rules When Visit Goes from Telehealth to Office
Question: If a visit starts as telehealth and the patient then comes to the office fo... Read more
Get to Know Coding Rules When Visit Goes from Telehealth to Office
Question: If a visit starts as telehealth and the patient then comes to the office fo... Read more
Reader Questions:
Pinpoint How to Report Glaucoma Screening
Question: Which code should we report for glaucoma screening? We typically report G0117 an... Read more
Pinpoint How to Report Glaucoma Screening
Question: Which code should we report for glaucoma screening? We typically report G0117 an... Read more
You Be the Coder:
Do You Know Which Codes Can Be Billed More Than Once?
Question: We perform taped and untaped fields for patients prior to blepharoplasty. We cur... Read more
Do You Know Which Codes Can Be Billed More Than Once?
Question: We perform taped and untaped fields for patients prior to blepharoplasty. We cur... Read more
ICD-10 Coding:
New Diagnosis Codes Describe Over a Dozen Corneal Conditions
Get more specific thanks to new laterality changes. If you've been following the annual I... Read more
New Diagnosis Codes Describe Over a Dozen Corneal Conditions
Get more specific thanks to new laterality changes. If you've been following the annual I... Read more
E/M 2021:
Use These Tips to Prepare for Upcoming MDM Changes
Your E/M coding will change dramatically in January — prep now to be ready. As most eye... Read more
Use These Tips to Prepare for Upcoming MDM Changes
Your E/M coding will change dramatically in January — prep now to be ready. As most eye... Read more
Accounts Receivable:
Capture More Income Opportunities with 4 Key Tips
Stop leaking money by instituting a few quick fixes. As COVID-19 cases continue to rise, ... Read more
Capture More Income Opportunities with 4 Key Tips
Stop leaking money by instituting a few quick fixes. As COVID-19 cases continue to rise, ... Read more
Tap Additional Revenue by Bringing Back Lapsed Patients
No matter how great the service is at your eye care practice, you're sure to experience p... Read more
No matter how great the service is at your eye care practice, you're sure to experience p... Read more
Reader Questions:
Is Modifier 26 Ubiquitous on X-ray Codes?
Question: My colleague and I are having a discussion. She says that we need a modifier on ... Read more
Is Modifier 26 Ubiquitous on X-ray Codes?
Question: My colleague and I are having a discussion. She says that we need a modifier on ... Read more
Reader Questions:
Don't Expect Refraction Pay
Question: When we perform refraction, should we use an E/M code like 99212 or an ophthalmo... Read more
Don't Expect Refraction Pay
Question: When we perform refraction, should we use an E/M code like 99212 or an ophthalmo... Read more
You Be the Coder:
Can You Justify High-Level E/M Codes for this Visit?
Question: Our new coder is having a hard time understanding the difference between a level... Read more
Can You Justify High-Level E/M Codes for this Visit?
Question: Our new coder is having a hard time understanding the difference between a level... Read more
ICD-10 Coding:
Can You Code These Eye Trauma Scenarios?
Don't skimp on coding when you see a patient with an urgent diagnosis. Although most eye ... Read more
Can You Code These Eye Trauma Scenarios?
Don't skimp on coding when you see a patient with an urgent diagnosis. Although most eye ... Read more
Global Packages:
Global Periods Go Beyond Surgical Procedures
Don't forget: You should check global days even for minor procedures. Your optometrists, ... Read more
Global Periods Go Beyond Surgical Procedures
Don't forget: You should check global days even for minor procedures. Your optometrists, ... Read more
Billing:
Bring in More Income by Instituting Stronger A/R Programs
Track every claim to ensure you've collected the maximum. Many eye care practices say tha... Read more
Bring in More Income by Instituting Stronger A/R Programs
Track every claim to ensure you've collected the maximum. Many eye care practices say tha... Read more
Here's What Your Financial Policy Should Include
An important element in your billing program is a financial policy that all patients must ... Read more
An important element in your billing program is a financial policy that all patients must ... Read more
You Be the Coder:
Can You Justify Reporting 99233?
Question: Our ophthalmologist saw an inpatient and treated her for diabetic retinopat... Read more
Can You Justify Reporting 99233?
Question: Our ophthalmologist saw an inpatient and treated her for diabetic retinopat... Read more
Reader Questions:
Coders Should Stay on Alert During Chart Reviews
Question: We brought on a new ophthalmologist who is very interested in medical codin... Read more
Coders Should Stay on Alert During Chart Reviews
Question: We brought on a new ophthalmologist who is very interested in medical codin... Read more
Reader Questions:
Do You Know When Modifier CS Applies?
Question: We recently received a bulletin about modifier CS, but it was written in a ... Read more
Do You Know When Modifier CS Applies?
Question: We recently received a bulletin about modifier CS, but it was written in a ... Read more
PHE Coding:
3 Facts About Medicare's Telephone Codes
You have until the end of the public health emergency to collect for these services. Your... Read more
3 Facts About Medicare's Telephone Codes
You have until the end of the public health emergency to collect for these services. Your... Read more
ICD-10:
Test Your Diagnosis Coding Skills With These Case Studies
Hint: Cataract codes may depend on cause. As coders work to navigate changing regulations... Read more
Test Your Diagnosis Coding Skills With These Case Studies
Hint: Cataract codes may depend on cause. As coders work to navigate changing regulations... Read more
Modifiers:
Use These 7 Tips to Guide Your E/M Modifier Use
Hint: These also apply to eye codes, Medicare reps say. Although every eye care physicia... Read more
Use These 7 Tips to Guide Your E/M Modifier Use
Hint: These also apply to eye codes, Medicare reps say. Although every eye care physicia... Read more
Reader Question:
Don't Bill the Payer for No-Show
Question: Our office has taken a financial hit since we've drastically reduced our ho... Read more
Don't Bill the Payer for No-Show
Question: Our office has taken a financial hit since we've drastically reduced our ho... Read more
Reader Question:
Mind the Medicare Rules for PHE Telehealth Billing
Question: How long are we allowed to bill telehealth under the relaxed rules? Our office i... Read more
Mind the Medicare Rules for PHE Telehealth Billing
Question: How long are we allowed to bill telehealth under the relaxed rules? Our office i... Read more
Reader Question:
Don't Expect Separate Slit Lamp Pay
Question: One of our optometrists uses a slit-lamp to check on healing after a foreign bod... Read more
Don't Expect Separate Slit Lamp Pay
Question: One of our optometrists uses a slit-lamp to check on healing after a foreign bod... Read more
You Be the Coder:
Pin Down E-Visit Codes
Question: Which E/M codes should I use if I see a patient for an e-visit? We have been doi... Read more
Pin Down E-Visit Codes
Question: Which E/M codes should I use if I see a patient for an e-visit? We have been doi... Read more
Telehealth Coding:
3 Tips Help You Report Telehealth Visits Under New Rules
Get to know how the rules changed in March. Your ophthalmology practice may not be confir... Read more
3 Tips Help You Report Telehealth Visits Under New Rules
Get to know how the rules changed in March. Your ophthalmology practice may not be confir... Read more
ICD-10 Coding:
Look to U07.1 for Confirmed Coronavirus Cases
When selecting the diagnosis code for this service, always review the date of service firs... Read more
Look to U07.1 for Confirmed Coronavirus Cases
When selecting the diagnosis code for this service, always review the date of service firs... Read more
Billing:
3 Tips Help You Improve Your Accounts Receivable
Boost your collections rate with these best practices. Are your practice's billing costs ... Read more
3 Tips Help You Improve Your Accounts Receivable
Boost your collections rate with these best practices. Are your practice's billing costs ... Read more
Reader Question:
Pinpoint Your External Cause Code Use
Question: When and how should we use external cause codes? New Mexico Subscriber Answer:... Read more
Pinpoint Your External Cause Code Use
Question: When and how should we use external cause codes? New Mexico Subscriber Answer:... Read more
Reader Question:
Know How to Calculate Capture Rate, Gross Profit Margin for Eyewear
Question: We just sat in on a webinar where they said every practice that sells eyewear sh... Read more
Know How to Calculate Capture Rate, Gross Profit Margin for Eyewear
Question: We just sat in on a webinar where they said every practice that sells eyewear sh... Read more
Reader Question:
Avoid Arguments When Patients Refuse to Pay
Question: We saw a patient who presented for an appointment, but he refused to pay a past ... Read more
Avoid Arguments When Patients Refuse to Pay
Question: We saw a patient who presented for an appointment, but he refused to pay a past ... Read more
You Be the Coder:
Answer This Question to Solve Patient History Issue
Question: If I have a chief complaint, an extended history of present illness (HPI), a pro... Read more
Answer This Question to Solve Patient History Issue
Question: If I have a chief complaint, an extended history of present illness (HPI), a pro... Read more
Compliance:
Tighten Your Practice's Cataract Procedure Documentation
Plus: Know how to spot documentation flaws that could land you in hot water. During the p... Read more
Tighten Your Practice's Cataract Procedure Documentation
Plus: Know how to spot documentation flaws that could land you in hot water. During the p... Read more
ICD-10 Quiz:
Test Your Vision Diagnosis Coding Skills With This Quick Quiz
From macular degeneration to screenings, make sure you're applying the right ICD-10 codes... Read more
Test Your Vision Diagnosis Coding Skills With This Quick Quiz
From macular degeneration to screenings, make sure you're applying the right ICD-10 codes... Read more
Medicare Advantage:
Ace Your Medicare Advantage Claims With These Quick Tips
Tip: Don't contact your MAC with Medicare Advantage questions. Medicare Advantage (MA) e... Read more
Ace Your Medicare Advantage Claims With These Quick Tips
Tip: Don't contact your MAC with Medicare Advantage questions. Medicare Advantage (MA) e... Read more
Reader Question:
Don't Spend Too Much Time Hunting for Schirmer's Test Code
Question: One of our physicians documented a Schirmer's test but we can't find the code fo... Read more
Don't Spend Too Much Time Hunting for Schirmer's Test Code
Question: One of our physicians documented a Schirmer's test but we can't find the code fo... Read more
Reader Question:
Get to Know Orbital X-Ray Codes
Question: How should we code an orbital foreign body X-ray that involves one PA view for b... Read more
Get to Know Orbital X-Ray Codes
Question: How should we code an orbital foreign body X-ray that involves one PA view for b... Read more
Reader Question:
MBI Verification May Be Necessary
Question: Our Part B MAC has now rejected three claims for invalid member identification n... Read more
MBI Verification May Be Necessary
Question: Our Part B MAC has now rejected three claims for invalid member identification n... Read more
You Be the Coder:
Can You Calculate Lucentis Units?
Question: Can you provide any advice about how many units of Lucentis® to report when the... Read more
Can You Calculate Lucentis Units?
Question: Can you provide any advice about how many units of Lucentis® to report when the... Read more
E/M Changes:
3 Tips Guide Your E/M Coding to Prep for Next Year
Big changes are coming in January — prepare now so you're ready. In less than a year, y... Read more
3 Tips Guide Your E/M Coding to Prep for Next Year
Big changes are coming in January — prepare now so you're ready. In less than a year, y... Read more
Compliance:
Evaluate Your Audit Risk With a Review of Your Common Coding Practices
We've got the tools you need to evaluate whether you're at risk of audit. Although every ... Read more
Evaluate Your Audit Risk With a Review of Your Common Coding Practices
We've got the tools you need to evaluate whether you're at risk of audit. Although every ... Read more
Get the Scoop on the Top 5 Codes Reported by Ophthalmologists, Optometrists
To get an accurate handle on where your coding stands compared to others in your specialty... Read more
To get an accurate handle on where your coding stands compared to others in your specialty... Read more
Reader Question:
Know the Rules for Add-on Codes
Question: What does the plus symbol in front of some E/M service codes signify? Ohio Subs... Read more
Know the Rules for Add-on Codes
Question: What does the plus symbol in front of some E/M service codes signify? Ohio Subs... Read more
Reader Question:
Get Specific for Modifiers When Global Is Involved
Question: Our ophthalmologist performed a complex cataract removal with IOL insertion on a... Read more
Get Specific for Modifiers When Global Is Involved
Question: Our ophthalmologist performed a complex cataract removal with IOL insertion on a... Read more
You Be the Coder:
Can You Report Results to Paying Party?
Question: Our local Department of Motor Vehicles asked our office to perform vision tests ... Read more
Can You Report Results to Paying Party?
Question: Our local Department of Motor Vehicles asked our office to perform vision tests ... Read more
E/M Coding:
Check Notes When Differentiating Between E/M, Eye Codes
Plus: Know which visits have a medical element. Unlike other specialties, eye care profes... Read more
Check Notes When Differentiating Between E/M, Eye Codes
Plus: Know which visits have a medical element. Unlike other specialties, eye care profes... Read more
Compliance:
Avoid These Common Issues to Stay off CMS' List of Errors
Report: Optometrists log more DME coding errors than any other specialty. Keeping track o... Read more
Avoid These Common Issues to Stay off CMS' List of Errors
Report: Optometrists log more DME coding errors than any other specialty. Keeping track o... Read more
Privacy:
Consider 7 Essential Tips to Keep Patient Info Secure in 2020
Update policies frequently, experts say. Your eye care practice is probably getting the h... Read more
Consider 7 Essential Tips to Keep Patient Info Secure in 2020
Update policies frequently, experts say. Your eye care practice is probably getting the h... Read more
Reader Question:
Take These Steps Following Internal Audit
Question: We read your article last month on internal audits and are starting to launch an... Read more
Take These Steps Following Internal Audit
Question: We read your article last month on internal audits and are starting to launch an... Read more
Reader Question:
Don't Automatically Write off Deceased Patients' Bills
Question: We are working to collect on an account and have just learned that the patient h... Read more
Don't Automatically Write off Deceased Patients' Bills
Question: We are working to collect on an account and have just learned that the patient h... Read more
Reader Question:
Separate Diagnoses Not Required for Modifier 25
Question: Our office manager says separate diagnoses are not required to use modifier 25, ... Read more
Separate Diagnoses Not Required for Modifier 25
Question: Our office manager says separate diagnoses are not required to use modifier 25, ... Read more
Reader Question:
Consider the Details When Repairing Lid Laceration
Question: Our ophthalmologist took a patient into the OR for repair of lid laceration and ... Read more
Consider the Details When Repairing Lid Laceration
Question: Our ophthalmologist took a patient into the OR for repair of lid laceration and ... Read more
You Be the Coder:
Eye 92100 for Diurnal Curve Testing
Question: Our ophthalmologist checked pressures over the course of several hours for glauc... Read more
Eye 92100 for Diurnal Curve Testing
Question: Our ophthalmologist checked pressures over the course of several hours for glauc... Read more
Part B Payment:
CMS: Ophthalmologists to see Biggest Pay Cuts in 2020
Ophthalmologists will experience a 10 percent hit in RVUs this year. With every new year,... Read more
CMS: Ophthalmologists to see Biggest Pay Cuts in 2020
Ophthalmologists will experience a 10 percent hit in RVUs this year. With every new year,... Read more
Compliance:
Find out How to Avoid This Ophthalmologist's Fate
Self-audits can help you catch these issues early. When your ophthalmologist performs sur... Read more
Find out How to Avoid This Ophthalmologist's Fate
Self-audits can help you catch these issues early. When your ophthalmologist performs sur... Read more
Look for These Issues on Audit Charts
Regardless of which auditing model your practice decides to adopt, it's a good idea to sta... Read more
Regardless of which auditing model your practice decides to adopt, it's a good idea to sta... Read more
Billing:
4 Steps Lead Your Eye Care Practice to Higher Revenue
Tip: Stop focusing on processes that won't move the needle. If your practice is like most... Read more
4 Steps Lead Your Eye Care Practice to Higher Revenue
Tip: Stop focusing on processes that won't move the needle. If your practice is like most... Read more
Reader Question:
Know What Info to Share With Collection Agencies
Question: We are about to turn some of our outstanding accounts to a collection agency. Ot... Read more
Know What Info to Share With Collection Agencies
Question: We are about to turn some of our outstanding accounts to a collection agency. Ot... Read more
Reader Question:
Always Check for Medical Necessity
Question: We just got a denial for “lack of medical necessity” for a procedure our sur... Read more
Always Check for Medical Necessity
Question: We just got a denial for “lack of medical necessity” for a procedure our sur... Read more
Reader Question:
Check for Updated Orbital Fracture Codes
Question: Our ophthalmologist evaluated an inpatient who was in a car accident. The patien... Read more
Check for Updated Orbital Fracture Codes
Question: Our ophthalmologist evaluated an inpatient who was in a car accident. The patien... Read more
You Be the Coder:
E/M Codes Not Typically Subject to Frequency Rules
Question: Our ophthalmologist performed an office consultation on a patient and his insure... Read more
E/M Codes Not Typically Subject to Frequency Rules
Question: Our ophthalmologist performed an office consultation on a patient and his insure... Read more