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Optometry Coding & Billing Alert

Visual Fields:
92082 or 92083? Choose Wisely With This Expert Strategy
With over $70 on the line, don't risk submitting the wrong code or inadequate documentatio... Read more
News You Can Use:
Congress Boosts Conversion Factor Through Dec. 31
Medicare Physician Fee Schedule rate won't be cut 23 percent. Although the government app... Read more
OIG Update:
Practices Collected Over $8 Million for Services Rendered After Patients Died
OIG identified massive overpayments for services rendered after patients' dates of death.... Read more
You Be the Expert:
Plaquenil Exam
Question: What diagnosis code should we use for OCT when the patient is currently on Plaq... Read more
Build a Better Business:
Has a Broken Payment Agreement Come to Dismissal?
Take these steps to end a practice/patient relationship without drama. If you have a pati... Read more
Reader Questions:
Spread Out 92250 and OCT Tests
Question: My Medicaid carrier just requested repayment for all claims for fundus photogra... Read more
Reader Questions:
Beware Tacking on Additional Patient Charges
Question: Can you charge a processing fee or a "statement" fee to past due patients when ... Read more
Reader Questions:
Don't Bill Under Another Provider's ID
Question: An optometrist in my office wants to bill services under another physician's ta... Read more
Reader Questions:
V67.00 Accurately Describes Follow-Up After Surgery
Question: If a patient receives treatment and the condition was resolved, which ICD-9 cod... Read more
Reader Questions:
Face Time Is Essential to Established Patient
Question: Our practice performed a test on a patient who was referred to us by another do... Read more
DME Reimbursement:
V2784 Strategies: Look to Modifiers KX, EY for Keys to DME Reimbursement
Keep medical necessity distinct from patient preference in documentation.If you're providi... Read more
Exam Coding:
Expand Your Coding Options For Patients Refusing Dilation
Tip: You can schedule a second office visit -- but beware this coding stipulation.You... Read more
Build a Better Business:
Navigate the Medicare Opt-Out Process in 3 Easy Steps
No Medicare does not equal no contracts.If you decided that 2011 is the year your practice... Read more
You Be the Expert:
PAM or VEP?
Question: Is 95930 the correct procedure code for potential visual acuity meter? Can this ... Read more
Reader Questions:
Dig In to Dry Eye Diagnosis
Question: Should I report a dry eye diagnosis code based on the optometrist's clinical fin... Read more
Reader Questions:
Save 'Foggy Vision' for Secondary Dx
Question: Many of our patients claim general reasons for their visit, such as "I can't see... Read more
Reader Questions:
No CCI Bundle? Here's Where to Find Modifier Details
Question: Sometimes I cannot find my two-code pair in the CCI edits. How do I know which c... Read more
Reader Questions:
Avoid Bilateral Modifiers on 76519, 92136
Question: The optometrist calculated IOL power in both a patient's eyes. Should I report t... Read more
Reader Questions:
Write-Off Doesn't Equal 1099
Question: We ended up writing off some patient balances as bad debts. Should we be sending... Read more
CPT 2011:
Prepare to Distinguish Between Optic Nerve and Retina Laser Scans
Tip: Your bilateral reporting options may change for SCODI next year.Frustrated by the lac... Read more
ICD-10:
Make Sure You're Ready: Get the ICD-10 Lowdown With Expert Guidelines
You'll need to implement the new 5010 claim form first to be ready for ICD-10. Whi... Read more
Overcome Delinquent Payer Headaches By Knowing Your State's Prompt Pay Laws
Remember: Medicare requires contractors to pay your clean claims within 30 days, but priva... Read more
You Be the Expert:
EOM Function Test
Question: My optometrist wants to code for a "detailed evaluation of EOM function." The di... Read more
Reader Questions:
Use 99201-99205 if Patient Switches to Your Office
Question: When I cover for another local private-practice optometrist, I code the office v... Read more
Reader Questions:
Avoid a 'Finders Keepers' Overpayment Mentality
Question: We've discovered that a patient overpaid us on her copay. We collected $50, whic... Read more
Reader Questions:
Code 92225 and 92250 Together When Medically Necessary
Question: When is it appropriate to bill for extended ophthalmoscopy and fundus photograph... Read more
Reader Questions:
Do Your Homework Before Hiring Outside Help
Question: Our practice just combined with another practice, and we're thinking about outso... Read more
Glaucoma Evaluation:
Determine Eligibility Before Looking to G0117 or G0118
The answers to the 2 questions below could bring $135 in to your practice.Choosing the cor... Read more
E/M Services:
Answer 'Separate' or 'Inherent' Question Before You Use Modifier 25
Not all pre-procedure services constitute a separate E/M.When an optometrist performs an E... Read more
Build a Better Business:
3 Steps Help You Uncover Missed Billing Opportunities With
Tip: The same audit process and timeline won't work for every office -- identify your... Read more
You Be the Expert:
A-Scan With Exam on Second Eye
Question: After we had done an A-scan on a patient prior to cataract surgery on his left e... Read more
Reader Questions:
Prove Necessity for Large Bifocal Segs
Question: I'm really confused about codes V2219 and V2319 for Medicare patients. I know it... Read more
Reader Questions:
Understand Both Sides of Gonioscopy Coding
Question: I know that Medicare looks at gonioscopy as a bilateral procedure. What about ot... Read more
Reader Questions:
Can You Not Submit a Claim to a Payer?
Question: We have a patient who wants us to give her the allowable amounts for a procedure... Read more
Fundus Photos:
Appending Modifier 50 to 92250? Not So Fast
Snap up your rightful fundus photo pay with bundling, Dx know-how.Adding too many -- ... Read more
Myth Buster:
Don't Let These Bilateral Blunders Stall Your Pay for Pre-Cataract Surgery Tests
Improperly coding IOL Masters or A-scans can cost your practice $30 per patient.Calculatin... Read more
Build a Better Business:
Test Your Collections Skills With 5 Questions
Know what your options are for non-par patients.You know that solid collections knowledge ... Read more
You Be the Expert:
Irritated Pinguecula
Question: Which diagnosis code should I use for an irritated pinguecula?Connecticut Subscr... Read more
Reader Questions:
Forget Modifiers for Bilateral VF
Question: As a retina office, we occasionally do visual fields. However, when I report 920... Read more
Reader Questions:
Rule-Out Diagnosis Coding Is a No-No
Question: My optometrist occasionally sees patients, and instead of coming to a conclusive... Read more
Reader Questions:
Pay Attention to Individual State WC Rules
Question: We had a patient who was injured on the job (workers' compensation) in Virginia ... Read more
Reader Questions:
Get to Know Capitation Contracts
Question: I'm confused about what capitation actually is and how we bill under capitation ... Read more
Post-Op Care:
4 Tips Help You Recoup Full Pay for Cataract Co-Management
Your follow-up service begins the day after the ophthalmic surgeon relinquishes care.You k... Read more
News You Can Use:
Welcome a 2.2 Percent Medicare Pay Boost For the Rest of This Year -- Finally
But the news isn't all good -- first, you faced a week of lower payments, and second,... Read more
Build a Better Business:
Keep Your Payments Coming In By Focusing on Timely Filing
With the Medicare deadline cut from three years to one, using a chart can help.As the impa... Read more
You Be the Expert:
Routine Exam for Keratoconus Patient
Question: How should I bill for a routine exam with the diagnosis post-keratoplasty in the... Read more
Reader Questions:
Use Most Specific ICD-9 Code for Visual Fields Claims
Question: We keep getting denials for 92082 and 92083 (Visual field examination ...) linke... Read more
Reader Questions:
Don't Echo Echography Code
Question: I'm trying to submit a claim for 76514 performed on both eyes, but I've been get... Read more
Reader Questions:
Make Sure Your EHR Passes PQRI Muster
Question: We have been participating in the physician quality reporting initiative (PQRI),... Read more
Reader Questions:
Clarify Temp Services Using Modifier Q6
Question: Our regular optometrist is taking some time off, and a temporary optometrist tak... Read more
Diagnostics:
Read This Before Your Next Extended Ophthalmoscopy Claim
Ensure you know what qualifies as an EO, and go beyond routine coding.Most eye exams inclu... 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 bilateral cod... Read more
Build a Better Business:
Part 2: Don't Let Patients' Financial Hardship Become Yours
A clear financial hardship policy might prevent some write-offs.You have a head start on u... Read more
Reader Questions:
Unbundle Slit Lamp Photos and Gonioscopies
Question: Our optometrist saw a glaucoma patient and performed a gonioscopy. The optometri... Read more
Reader Questions:
Modify Eye Codes Just Like E/M Codes
Question: I just started working in an optometrist's office and I have a question about mo... Read more
Reader Questions:
Collect Medicare Copay Up Front
Question: We have many patients on Medicare in our practice. When a Medicare patient prese... Read more
You Be the Coder:
VFs Ordered by Outside Doctor
Question: We performed a visual field ordered by a doctor outside our practice. The patien... Read more
FBR:
Bust These Foreign Body Removal Myths for Foolproof Claims
Treating punctal plugs like FBRs? Read this first.Even more irritating than having somethi... Read more
ICD-10; Get the Real Story on ICD-10 With These Expert Answers
Hint: You will be able to find hard copy ICD-10 books -- and dozens of new cataract c... Read more
Build a Better Business:
Speed Up New Patient Data Capture With 5 Tips
Streamline your collections system and get your deserved money faster with these practice ... Read more
Reader Questions:
Don't File PRK Follow-Up by Second Optometrist
Question: We got a patient for a PRK follow-up exam. He had the surgery done at another fa... Read more
Reader Questions:
Conduct 3 Tests Before Coding Diurnal Curve Encounters
Question: Is there a code for "diurnal curve testing," during which the optometrist checks... Read more
Reader Questions:
Can Provider Change Tax ID?
Question: One of our optometrists wants to stop billing under the group's tax ID and start... Read more
Reader Questions:
Write Off Medicaid Secondary Balances
Question: A patient has a Medicare replacement plan and then has Medicaid as secondary ins... Read more
You Be the Coder:
Blepharitis Type Drives Diagnosis Coding
Question: What is the proper ICD-9 code for patients with blepharitis?Tennessee Subscriber... Read more
CPT:
6 Tips Guide You to More Accurate Contact Lens Claims
Clear the air on appropriate codes to boost practice revenue. Getting insurance claims pa... Read more
Build a Better Business:
Use an EHR System to Your Billing Advantage
Up-front costs could give way to savings in many areas. Streamline your collections syste... Read more
You Be the Expert:
Low-Risk Glaucoma Screenings
Question: Our office sometimes performs glaucoma screenings for patients who don't m... Read more
Reader Questions:
Does Old BB-Gun Injury Have Bearing on Coding?
Question: We have a patient who came in for a routine eye exam, but reported retinal dama... Read more
Reader Questions:
Don't Put Suspended Claims on the Back Burner
Question: My office has a few claims that have missing or incorrect information. I'm new ... Read more
Reader Questions:
Apply Initial EO Code to New Condition
Question: I'm confused about the extended ophthalmoscopy codes. Is 92225 for a new patien... Read more
Reader Questions:
Face Time Is Essential to Established Patient
Question: Our practice performed a test on a patient who was referred to us by another do... Read more
Reader Questions:
Billing Before Credentialing? Check With Carrier
Question: Our practice is expanding and we will soon have two new optometrists starting w... Read more
Reader Questions:
3 Details Drive RVU Calculations
Question:  How do I determine which RVUs to use in the Medicare fee schedule for rei... Read more
4 Tips Point the Way to Crystal-Clear OCT Coding
Learn when you can, and should, report 92135 more than once to gain $44. When y... Read more
Watch Key Conditions to Scratch Eye Allergy Coding Itch
Get the specifics on eye irritation to find the most accurate diagnosis code. The sprin... Read more
You Be the Expert:
Find the Right Dx for Pseudostrabismus
Question: What ICD-9 code should I report for a diagnosis of pseudostrabismus? Arizona ... Read more
News You Can Use:
CMS Clamps Down on Physician Signature Requirement
CERT has contractors denying claims that would have squeaked by in 2008. CMS has releas... Read more
Build a Better Business:
Update Your PECOS File Now to Ensure Payment Later
Hint: You'll need the system's electronic funds transfers in order to get paid. Streaml... Read more
Reader Questions :
Is Routine Reporting of 92002, V72.0 OK?
Question: Our office has been coding exams (routine exams) as 92002 and V72.0 when we don... Read more
Reader Questions :
Use Patient Complaint for FBR Coding
Question: I saw a patient yesterday who had a conjunctival foreign body. I billed 65205 a... Read more
Reader Questions :
Ease the Pain of Confirming Patient Information
Question: We update important patient information,such as insurance, address, emergency c... Read more
Reader Questions :
Look Into Options for Handling Late or No-Show Patients
Question: We have a few patients who routinely miss appointments or show up late. We'd li... Read more
Get to Know Payer Specifics for Gonioscopy
3 FAQs clear up your 92020 coding to improve your claims' success. With only one code for... Read more
You Be the Expert:
Aim for Proper Ametropia ICD-9 Code
Question: Which ICD-9 code should I report for ametropia? Kansas Subscriber Answer: ... Read more
Resolve 'Medical vs. Vision' Insurance Coding Mixups
When your patient has both types of insurance, who gets the bill? Let the reason for the v... Read more
Build a Better Business:
Don't Let Patients' Financial Hardship Become Yours
Discounts and write-offs are options, if you follow these guidelines. That a patient may ... Read more
READER QUESTIONS:
Document Chief Complaint for Glaucoma Follow-Up
Question: How should I code an office visit for a wheelchair-bound nursing home patient w... Read more
READER QUESTIONS:
Find 'Track or Treat' Evidence for 92285 Claims
Question: Our optometrist performs external ocular photography for a Medicare patient wit... Read more
READER QUESTIONS:
Check to See If CMS Signed You Into PECOS
Question: I keep hearing about PECOS, but I'm so confused about the whole thing. Do I nee... Read more
READER QUESTIONS:
Understand Your Obligations for Overpayments
Question: Some insurers are deducting overpayments from our checks for visits or services... Read more
READER QUESTIONS:
Append GY to Refraction Claims
Question: A doctor recently told me that appending modifier GY to the refraction code wou... Read more
Make Sure Techs' Work Meets Incident-To Standard
Their services can boost the E/M level -- but the OIG is always watching. If an audi... Read more
News You Can Use:
Legislators Offer New Year's Gift With Temporary Pay Fix
You'll face a 10-day delay from MACs as they update their claims systems. Good news: Desp... Read more
CMS's Refusal to Pay Consults Makes MSP Claims a Headache
If you bill 99241-99255 to private payers, good luck getting Medicare secondary balance. ... Read more
Build a Better Business:
Weigh Pros and Cons Before Kissing Medicare Goodbye
Reduced patient pool, satisfaction may trump easier payment process. With the threat of s... Read more
You Be the Expert:
Unilateral Visual Fields
Question: I'm confused about coding for visual fields (VF). The code description says "un... Read more
Reader Question:
Don't Change Insertion Code by Plug Type
Question: We use both temporary and permanent punctal plugs. Should I code differently fo... Read more
Reader Question:
Beware Reporting Fundus Photos With HRT
Question: Can I report a fundus photo and a Heidelberg retina tomograph (HRT) on the same... Read more
Reader Question:
Give Collections Agencies All the Details
Question: We've decided to turn over some of our outstanding accounts to a collection age... Read more
Reader Question:
Avoid Underpayment From SNFs With a Contract
Question: We consistently have trouble collecting for services our physicians provide to ... Read more
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