Ophthalmology and Optometry Coding Alert

Diagnostic Testing:
Understand Visual Field Test Coding With 4 Quick FAQs
Hint: Always be sure to differentiate 92082 from 92083. Visual field testing (92081-9208... Read more
IOL Mythbuster:
Bust These Myths to Collect for IOL Power Calculations
Keep bilateral rules in mind as you navigate these coding situations. Before a patient c... Read more
Medicare Errors:
Are Your Lab Orders Complete? This Part B Payer Is Watching
E/M coding also ranks high on the MAC's watch list. Coding involving lab orders, E/M ser... Read more
Reader Questions:
Have Modifier 25 Rules Changed?
Question: Have the modifier 25 rules changed now that the E/M guidelines are different? My... Read more
Reader Questions:
Understand the Latest on 99211
Question: What are the minimum documentation requirements needed to bill 99211? What has t... Read more
Reader Questions:
Prep Now for New RTM Codes
Question: We read about new remote therapeutic monitoring codes coming out. Can you tell u... Read more
You Be the Coder:
Can You Code a Retinal Migraine?
Question: Notes indicate that the provider treated a patient with a “retinal migraine.... Read more
Compliance:
Avoid This Ophthalmologist’s Fate by Performing Self-Audits to Catch Issues Early
Coders: Always cross-check codes billed against the documentation. When your ophthalmolog... Read more
Test Supervision:
Nail Down Supervision Requirements for Eye Tests With a Few Quick Tips
Diagnostic test supervision differs from incident-to supervision. You've memorized the su... Read more
ICD-10:
Test Yourself With 3 Diagnosis Coding Questions
Understand what happens if no diagnosis is discovered. In some cases, coding the diagnose... Read more
Reader Questions:
Remember Foreign Body Coding Advice
Question: A patient came in after having put glue in her eye because she mistook the small... Read more
Reader Questions:
Understand the Nuances of Modifiers 22, 52
Question: When can we use modifier 22 to get paid more for a complicated procedure? I am p... Read more
Reader Questions:
Remember That Payers Append Modifier 51 When Needed
Question: When billing a muscle surgery with adjustable suture add-on, should I use modifi... Read more
Reader Questions:
Know the Rules Around Free Samples
Question: In the past, ophthalmologists in our practice have frequently supplied free samp... Read more
You Be the Coder:
Can You Code a Conjunctival Cyst Removal?
Question: Our ophthalmologist removed a conjunctival cyst, but did not incise or drain it,... Read more
CPT® 2022:
Check Updates to 99211, Retinal Detachment Treatment Codes Effective Jan. 1
Fortunately, the latest edition of CPT® isn't as earth-shattering as last year's. When t... Read more
ED Coding:
Bust 3 Myths for Clean Emergency Department Coding
Although the office-based E/M codes were overhauled earlier this year, that wasn't the cas... Read more
Documentation:
Nail MDM Using the Concept of ‘Think in Ink’
Check these expert tips to tally the number and complexity of problems addressed. You've ... Read more
You Be the Coder:
How Far Back Should History Go?
Question: Our eye care physician documented that a patient had “childhood measles 10 yea... Read more
Reader Questions:
Non-Medicare Payers May Perform Audits
Question: We treat pediatric patients who require ophthalmology care, so we don't submit m... Read more
Reader Questions:
Check Insurance Details, Even Near Year’s End
Question: We saw an established patient for a glaucoma check and when the remittance advic... Read more
Reader Questions:
Get to Know Corneal Abrasion Codes
Question: A new patient came in with pain, redness, and tearing in her right eye. She mowe... Read more
Reader Questions:
Know When Modifier 25 Applies
Question: When a patient with a foreign body or chalazion comes in as a referral from anot... Read more
Reader Questions:
States May Dictate e-Signature Rules
Question: Our small practice still sees a majority of our Medicare beneficiaries via teleh... Read more
ICD-10-CM Coding:
New Diagnosis Codes to Debut for COVID-19, Social Determinates of Health
Plus: You'll find revised code for Sjogren syndrome with keratoconjunctivitis. If your pa... Read more
Part B Payments:
Latest Fee Schedule Proposal Includes Updates to Telehealth Policies
But conversion factor cuts could impact all medical practices if proposal is finalized. ... Read more
Procedures:
Collect for Punctal Plug Procedures With These Tips
Hint: Procedure code isn't dependent on type of plug. One way eye care specialists can h... Read more
Check These Tips When Fighting Punctal Plug Denials
You've coded what you're sure is a bulletproof claim for an E/M code and punctal plug inse... Read more
You Be the Coder:
Can You Code a PAM Test?
Question: Is 95930 the correct procedure code for potential visual acuity meter? Can this ... Read more
Reader Questions:
Know When Dye Is Included
Question: One of our physicians wants to know if we can bill for indocyanine-green dye. He... Read more
Reader Questions:
Get to Know Scribe Rules
Question: We just started having one of our medical assistants act as a scribe for a physi... Read more
Reader Questions:
Query Physicians Without Adding Leading Questions
Question: Thank you for your article in Vol. 24, no. 7 on documentation tips. We read it ... Read more
Compliance:
Collect for Your Post-Cataract Contacts, Glasses Every Time
Hint: It's important to know whether your patient has gotten free glasses following prior ... Read more
Follow These ABN Best Practices When Dispensing Deluxe Frames
If your patient is likely to qualify for a free pair of glasses or contacts following cata... Read more
Incident-To Coding:
5 Tips for Billing Incident-To Services
Hint: Don't meet the requirements? Bill under the APP's NPI. When you're reporting incid... Read more
You Be the Coder:
Can You Untangle This Drug Therapy MDM Question?
Question: What qualifies as “drug therapy requiring monitoring” in the high-risk level... Read more
Reader Questions:
Use Caution When Reporting Prolonged Telehealth Service
Question: Our provider performed an E/M service over the phone that lasted 55 minutes. Can... Read more
Reader Questions:
Understand What Constitutes a HIPAA Violation
Question: I appreciated your article last month about HIPAA compliance, and we are trying... Read more
Cataract Excisions:
Get to Know What Makes Cataract Removal ‘Complex’
Look carefully at the op report before reaching for 66982. Myth: You should report the co... Read more
Documentation:
Bust These 5 Documentation Myths to Perfect Your Medical Records
Hint: When Part B reps request records, send them swiftly. If you think each patient's ... Read more
HIPAA:
Consider These Tips to Steer Clear of Privacy Breaches
You should take HIPAA seriously — because insurers do. Ever wonder whether the governme... Read more
You Be the Coder:
Confirm Retinal Break to Report H33 Series
Question: Our retinal doctor performed a surgery for a retinal detachment (67108) and said... Read more
Reader Questions:
Count One Eye for Each Strabismus Code
Question: Our surgeon performed a resection procedure on two horizontal muscles for strabi... Read more
Reader Questions:
Count Conference Toward E/M Code
Question: Our ophthalmologist treated a patient with severe eye injuries due to a car acci... Read more
Reader Questions:
Set a Schedule to Avoid Seeing Denials Pile Up
Question: We performed a self-audit two months ago and identified over a dozen denied clai... Read more
Reader Questions:
Denote Corrections, Even in EHR
Question: We are aware of how to correct a mistake on a paper medical record, but how do w... Read more
Ophthalmology Tests:
Check This Comprehensive Guide to Report Diagnostic Tests Correctly
Every practice performs pre-exam tests, so ensure that you collect for yours. When patie... Read more
Which Services Are Included in the Visit?
You should be aware of what Medicare already considers to be included in your office visit... Read more
What Documentation Must the Record Include?
When submitting a claim for an ophthalmic test, the record must include any photos, scans,... Read more
Coding Accuracy:
Check These Self-Audit Tips to Boost Your Bottom Line
You can't afford not to check in on your practice's billing accuracy. The word “audit... Read more
Guide Your Self-Audits With This Quick Checklist
Eye care coders who have never performed a self-audit may wonder whether they have what it... Read more
Reader Questions:
Consider Reporting Bifocals on Two Claim Lines
Question: How would I go about coding for a progressive bifocal to those plans that pay fo... Read more
Reader Questions:
Check This Repeat Focal Laser Scenario
Question: We had a patient return during the 90-day postoperative period of a focal laser ... Read more
Reader Questions:
Code Tumor Secondary to VF Defect
Question: How would you code a visual field defect arising from pituitary adenoma? Flori... Read more
You Be the Coder:
Which Modifier Applies to Injection During Global?
Question: A patient came in during the global period for a procedure on her left eye with ... Read more
Eye Exams:
Could You Be Coding Comprehensive Eye Exams Incorrectly?
Reviewers took a close look at coding ophthalmological services. If you ever wonder where... Read more
Diagnosis Coding:
Can You Code These Retinal Disorders?
Take this short quiz to evaluate your retinal coding know-how. Most eye care practices se... Read more
Documentation:
Square up Your Documentation With Tips From Part B Reps
Hint: You can amend the medical record in some circumstances. Not only does your medical ... Read more
Ensure You Meet Signature Rules With These Tips
Once you've tightened up your medical documentation, there's one last piece of the equatio... Read more
Reader Questions:
Avoid Overlapping Notes
Question: We have a longtime patient who we have recently been seeing for a new workers co... Read more
Reader Questions:
Collect Copays, Even If You’re Non par
Question: Do we have any obligation to try to collect copays or deductibles when we are no... Read more
You Be the Coder:
Differentiate G0117 From G0118
Question: We cannot figure out which code we should bill when we perform a glaucoma screen... Read more
Compliance:
Avoid Making the Mistakes These Optometrists Made
CMS says optometrists logged startling 84 percent DME error rate. Eye care coders have to... Read more
Check out CMS’ Review Benchmarks
CMS identified a total of $25.74 billion in total improper payments among providers sample... Read more
Part B Coding:
Check These 4 Essential FAQ Answers for Clean Eye Care Coding
Part B reps answered several burning questions during a recent session. Are you vexed by... Read more
Modifier Clip And Save:
Nail Down Your Bilateral Billing Rules With This Guide
Bilateral procedures are common in ophthalmology practices, since medical issues often aff... Read more
Reader Questions:
Is Modifier 51 Required?
Question: We have a coder who puts modifier 51 (Multiple procedures) on almost all surgica... Read more
Reader Questions:
Keep Medical Necessity at Top of Mind for Baseline Images
Question: An ophthalmologist in our practice would like to offer baseline photos, taken wi... Read more
Reader Questions:
Look to 65210 for Conjunctival Concretion Removal
Question: Can you help me determine the right code for removing conjunctival concretions? ... Read more
You Be the Coder:
How Many Lucentis Units Should You Report?
Question: We just administered Lucentis injections for the first time, and it was very exp... Read more
ICD-10 Coding:
Give Your Eye Care Diagnosis Coding a Tune-Up With These Tips
Can you code this diabetic retinopathy scenario? Although some diagnosis coding scenarios... Read more
E/M Coding:
Master the New E/M Rules With 8 Solid Facts
These tips come straight from Part B reps. Eye care practices are now a few months into ... Read more
Reader Questions:
Understand the Hospice Payment Steps
Question: Medicare recently denied a service that our ophthalmologist provided to a patien... Read more
Reader Questions:
ABN With Contact Lens Fitting? Check This Advice
Question: Are patients undergoing a keratoconus workup or contact lens fitting still requi... Read more
Reader Questions:
Modifiers Won’t Always Unlock Payment
Question: A patient returned during the 90-day postoperative period of a focal laser for a... Read more
You Be the Coder:
Is Pupil Stretching Separately Billable?
Question: Our ophthalmologist wants me to submit a claim for cataract excision (66982), al... Read more
Reimbursement:
10 Ways Your Eye Care Practice Can Bring in More Cash This Year
Some practices are seeing revenues that are half of what they were before COVID hit. The... Read more
Vision Testing:
Know Which Eye Test Codes Require You to Retain Images
In some cases, reimbursement could be at risk if you don't hang on to photos. When it co... Read more
Reader Questions:
Avoid Reporting Lidocaine in Most Situations
Question: Is there a code we should bill for subcutaneous lidocaine or lidocaine with epin... Read more
Reader Questions:
Separate Diagnoses Not Required for Modifier 25
Question: Our optometrist says separate diagnoses are not required to use modifier 25, but... Read more
Reader Questions:
Medicare May Pay for Noncovered Workers’ Comp Visit
Question: When the patient has workers' compensation and Medicare, and workers' comp doesn... Read more
You Be the Coder:
Check Z01.0 Series for Vision Screenings
Question: A 12-year-old patient presented to our eye care practice after failing a school ... Read more
CPT® 2021:
Get the Scoop on New Eye Care Codes With 3 Tips
Hint: Don't forget new Category III codes. Eye care practices are ringing in the new year... Read more
Compliance:
Check for Medical Necessity in Every Chart to Avoid Audit Scrutiny
Avoid the fate of this optometrist, who must pay over $3 million back to Medicare. Have y... Read more
Do You Understand What ‘Medical Necessity’ Means?
Although we hear the term “medical necessity” often, some coders aren't sure exactly w... Read more
E/M Coding:
Let These FAQs Guide Your 2021 E/M Plans
Check the expert answers to ensure you're coding correctly. You've adjusted your superb... Read more
Reader Questions:
Tonometry Requires Multiple Measurements
Question: The optometrist evaluated a patient's pressures multiple times over the course o... Read more
Reader Questions:
Check the Muscle Involved for Accurate Strabismus Coding
Question: Our ophthalmologist performed a right medial rectus disinsertion/reinsertion of ... Read more
Reader Questions:
Know When Bilateral Modifiers Are Needed
Question: Our ophthalmologist performed a corneal topography on each eye during the same s... Read more
You Be the Coder:
Remember the Essential Bundling Edits
Question: Our new office manager is facing some confusion about what codes we would report... Read more
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