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    Wiki Z96.1 w/ H59.811

    is this correct ? our 2023 ICD10 books clearly states that Z96.1 is excludes 1 to H59.811 and should not be billed together, but our administrator is using some other resource and is pulling some kind of exception rule that is not stated in ICD10 texts. Any advice or comments are appreciated :)
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    Wiki Only drawings for exam findings, is it billable?

    We have a doctor who is adamant about not using EHR. And, yay!, he finally agreed to do it! He does not have time to verbalize his findings, however, due to the volume of his clinic. He is currently drawing all of his findings in a paper chart. We were able to find a way for his scribe to...
  3. A

    Wiki ophthalmology injections

    Can two eyes be billed on the same day? For example, we use 67028 and J9035 regularly, very rarely do we have an eyelea injection. When I bill 67028 50 and double the price, most insurance companies are denying, including Medicare. I bill J9035 2 Units double the price and typically that has no...
  4. K

    Wiki Billing for OCT's

    Hello all! Just trying to figure out if you can bill 92132 and 92133 on the same date of service? If they are not billable, is there any modifier that can be used to bill them together? Thank you!
  5. C

    Wiki KX MOD in a ASC

    I code for the facility not the professional services. I am being asked to review a claim that denied due to Pt has meet max benefits for the year. The AR rep is stating they were advised that this case scenario may meet the requirements to add the KX modifier. When would it be appropriate to...
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    Wiki DMEK/DSEK

    One of my doctors performed a DMEK on a patient and now 4 days later is doing a DSEK on the same eye. he says it is due to faulty donor tissue and not surgeon or patient error. would i bill the DSEK normally? or is there a different code i should use?
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    Wiki Skilled Nursing Facility E&M Codes

    It was brought to my attention that medical evaluation and management CPT Codes (9920* - 9921*) reported by our Optometrists and Ophthalmologists could be rejected by CMS when billed in a SNF-Skilled Nursing Facility-setting (POS 31, 32, etc.). I have read conflicting info indicating Optometry...
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    Wiki ASCAN coding question: unilateral vs bilateral cataract

    One of our providers has informed me that ASCAN coding should always reflect a bilateral procedure. The problem for me is that I often see this procedure performed bilaterally even when the cataract diagnosis is unilateral (H25.12, for example). Does anyone know if it's okay to link the 76519...
  9. S

    Wiki Bill diagnostic test for TC alone from outside referral?

    We have outside physicians refer patients to our clinic for the sole purpose of using our diagnostic equipment. Can we bill for the TC of the test(s) performed? If so, a technician is the one that performs the service (with no interpretation), who would we list as the rendering provider on our...
  10. K

    Wiki Optometrist Billing IOL for Cataract Surgery

    I know generally cataract surgery and pre-ops are preformed by an Ophthalmologist, but our Optometrist will be co-managing a pt's case with another facility that will be preforming the cataract surgery. They want our OD to perform the IOL (92136) and necessary measurements for implanting the new...
  11. K

    Wiki New Patient Exams

    Recently I attended the WAEPS billing code quest seminar and something the speaker said raised a lot of questions. I have always billed a new patient as a patient that has not been seen by our practice in the last three years or at all, but the speaker said that if a patient is seen by a...
  12. K

    Wiki Delight's #1 Fan

    I have always been told that the diagnosis has to be documented in the A/P. Someone is telling me that the specific type of cataract can be pulled from the eye exam. Is this true?
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    Wiki Ophthalmology Webinar on 2-8-17

    Hello, Did anyone attend or watch the recent AAPC ophthalmology webinar? Can you tell me if the contents would be relevant to a medical optometry biller? TIA
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    Wiki Lucentis Injections

    Hello Everyone, My administrator has asked me to verify payment of a Lucentis Injection for a patient who has a MediCal HMO. The facility has an authorization for the procedure, which includes the J2778, as well as the 67028. The IPA for the HMO is stating as long as I have the approval, it...
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    Wiki Billing Post Op Eyeglasses after Cataract Surgery to Medicaid

    I work in an ophthalmology office and am constantly billing post operative eyeglasses for cataract surgeries to DME and have had no problem getting them paid. (We use CPT codes V2303, V2305, etc. and ICD-10 code Z96.1). I have recently tried billing Medicaid for a pair of post operative...
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    Wiki Intravitreal Injection (CPT 67028) - Can the ASC AND the Surgeon bill?

    Our provider sometimes performs Intravitreal Injections of Avastin in the Ambulatory Surgery Center when performing other procedures. We know the ASC bills for the facility. We just wanted to verify that the surgeon is also able to bill this code for the professional portion of this procedure...
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    Wiki Billing ophthalmology

    I was wondering if when billing an office with a procedure, would you also include the modifier 25. Like in billing in the family practice. Please advise me, I'm new to billing ophthalmology. Thanks in advance
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    Wiki Auditing sheet for Ophthalmology

    I need assistance finding a good auditing form for Ophthalmology. I need assistance counting the bullets... any help is appreciate .
  19. K

    Wiki Ophthalmology Resources

    Hello - I am new to coding outpatient ophthalmology services. Can anyone recommend a good resource to purchase for these surgical procedures. Thanks
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    Wiki MAIA Macular Integrity Testing

    Post closed This post is closed.
  21. R

    Wiki Modifier 51 on diagnostic test codes

    Does modifier 51 apply to diagnostic procedure codes or just surgical codes? If it applies to diagnostic codes, under what circumstances should it be used? What about ophthalmology diagnostics - if one procedure is performed by a tech and another by the physician, should we use modifier 51?
  22. S

    Wiki Ophthalmology Practice - E/M Documentation Issue

    Who can document the Exam elements in an Ophthalmology practice? Is it strictly the MD/OD or can the C.O.T. (tech) document and have them be counted as exam elements to establish the E/M level that is being billed? I am in the process of starting a chart audit in the practice I work at and am...
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    Wiki 66984 with 65772

    I have a Ophthalmologist who is doing cataract surgery (66984) and at the same time is doing a corneal relaxing incision (65772) because his 66984 will cause an astigmatism and he doesn't want to inconvenience the patient by having them come back at a later time to have that fixed. The CPT book...
  24. M

    Wiki Ophthalmology 920XX vs E/M

    How does one decide to assign an ophthalmology code 920XX vs E/M for a visit?