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Ophthalmology and Optometry Coding Alert

2005 RVU Update:
How Will Your Office's Fees Fare in the New Year?
You'll earn 32 percent more for B-scans, and lose over 40 percent for some conjunctiv... Read more
Chart the Changes to 2005 RVUs That Will Have the Greatest Impact on Your Bottom Line
Where are the fees for ophthalmologists' services going next year - up or down? Keeping tr... Read more
ICD-9 Brushup:
Zoom In on 5th Digit for Accurate Cataract Diagnosis
Communicate with your doctors to find the most specific code, or risk losing $695 in reimb... Read more
Reader Questions:
Stick to V2521 for Astigmatic Contacts
Question: Which code should we use for monthly replacement toric contacts? We have been us... Read more
Reader Questions:
Report Unrelated Fundus Photos Without Modifier
Question: We have a patient still in the global postoperative period for cataract surgery.... Read more
Reader Questions:
Know the Trick to Reporting Trichiasis Procedure
Question: How should I code the work when a patient came in for a complete eye exam, and t... Read more
Reader Quesitons:
Get Physician's Help to Back Up Modifier -22 Claims
Question: We often experience delays in payment or partial denials when we use modifier -2... Read more
Reader Questions:
Determine New Patient Status by 3-Year Rule
Question: Can we report a new patient code if a patient stops seeing one ophthalmologist i... Read more
Reader Questions:
Forget Modifier -51 for Most Payers
Question: I notice CPT includes a modifier (-51) for "multiple procedures." I never append... Read more
You Be the Coder:
Botox-Induced Tarsorrhaphy
Question: We have a patient with a corneal ulcer and herpes zoster. To help the healing pr... Read more
Master These Complicated Strabismus Coding Cases to Avoid Costly Denials
Billing bilaterally can save you $130 per procedureA simple mistake coding the many combin... Read more
Quick Key:
Find Codes Fast for Strabismus Procedures
Follow the chart to get the right CPT code for almost every combination of eye musclesWith... Read more
Clarification:
Consultations Versus Visits
The answer to a reader's question in the October Ophthalmology Coding Alert ("Learn the 3 ... Read more
OIG Update:
Stay on Inspectors' Good Side By Using Modifiers Wisely
HHS will scrutinize your unbundling next year - are you ready?How confident are you in you... Read more
Reader Question:
Using Wrong Lesion Size Can Shrink Payment
Question: When determining the size of an excised  lesion, should I go by the operati... Read more
Reader Question:
Appeal Workers' Comp if Documentation Supports You
Question: A patient came in for a foreign-body removal. We billed the workers' comp carrie... Read more
Reader Question:
Ask Doctor for Correct Units of Measurement
Question: How should I code for a 1-cc injection of Kenalog-40? The HCPCS code only mentio... Read more
Reader Question:
Apply Global Rules to On-Call Doctor
Question: One of our surgeons performed laser surgery on a patient, and then went on vacat... Read more
Reader Question:
Don't Mistake Gold Weights for Foreign Bodies
Question: How should we code for removing gold weights from the eyelids? We have a differe... Read more
You Be the Coder:
Is Primary Diagnosis Routine or Medical?
Question: A patient came in stating that she had no changes in vision - she just wanted he... Read more
Simplify Complex Cataract Coding
Reporting 66982 just because of surgical complications could land you in deep troubleWhen ... Read more
Watch for Red Flags for Complex Cataract Procedures
These factors may complicate extractions, but they're not enough for 66982A statement from... Read more
NCCI Update:
Include Graft Harvesting in Conjunctivoplasty
On Oct. 1, you'll code lesion and pterygium excisions differently In January 2004, CPT add... Read more
CPT 2005 Update:
Cyclophotocoagulation Coding Could Get Easier Next Year
Reporting same-day A-scans and B-scans may also be simpler, experts sayWith just over thre... Read more
Stay Current on CPT Updates, Even if Payers Don't
Here's how to get paid when insurers don't recognize the new codes Just because Medicare e... Read more
5 Questions - and Expert Answers - Help You Decide Whether to Opt Out of Medicare
Analyze your patient base to see how opting out will affect your bottom lineIf your practi... Read more
You Be the Expert
Private-Payer Noncovered Services Question: What should our billing office do when our phy... Read more
Opting Out of Medicare? 13 Essentials for Private Contracts
Follow Medicare's rules to leave Medicare behindBefore you opt out of Medicare, make sure ... Read more
Reader Question:
Include Multiple Canal Probes in 68840
Question: I need some help with CPT code 68840. Is this billed bilaterally, with modifiers... Read more
Reader Question:
Don't Look for Code for No-Shows
Question: We regularly have patients who don't show up for their appointments and don't te... Read more
Reader Question:
Choose ABN or NEMB Based on Denial Prediction
Question: For what codes or procedures should I use the "Medicare Noncovered Services Rele... Read more
Reader Question:
Learn the 3 R's for Successful Consultation Billing
Question: What is the correct way to bill a consultation in the emergency department? An E... Read more
Reader Question:
Don't Shun Coding Scleral Graft With Aqueous Shunt
Question: If I'm reporting a shunt procedure, can I code separately for the scleral patch ... Read more
Reader Question:
Provide Copies of Medical Records to an Outside Auditor
Question: When our outside auditor gets copies of chart notes to perform an audit, the pat... Read more
You Be the Coder:
2 Photocoagulation Sessions Within 1 Global Period
Question: A patient presented with background diabetic retinopathy and retinal edema in he... Read more
Clear Up Retinopathy Coding With 5th-Digit Revisions
Sweet news for coders - you won't have to check insulin use to find the right diabetes cod... Read more
Cut to the Chase With Eyelid Lesion Coding
Reviewed May 18, 2015 Integumentary codes or eyelid excision code? Picking the wrong... Read more
Look for New V Code to Track Insulin Use
Deletions don't mean you can ignore insulin dependence completely He may no longer rely on... Read more
Clip and Save:
Eyelid Lesion Removal Codes
Keep this chart handy to help find the right CPT code based on the size, number and locati... Read more
Reader Questions:
Use Comments Box for Topography
Question: Would you please tell me which procedure code I should use when billing for topo... Read more
Reader Questions:
Back Off From Modifier -24 Post-Cataract Surgery
Question: When my ophthalmologist sees a patient for a preoperative exam before cataract s... 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:
67311 Doesn't Require Surgery on Same Muscle
Question: One of our doctors operated on a vertical muscle of the right eye. Later, he ope... Read more
Reader Questions:
Determine Consult POS by Patient Status
Question: We saw a patient who was considered an inpatient and was brought to the office b... Read more
You Be the Coder:
Report Postoperative Care Accurately and Ethically
Question: Our practice has one doctor (Dr. A) who comes to our office from another state o... Read more
Tighten Up Your Ptosis Repair Coding
Document medical necessity and save $500 per procedureBlepharoplasty and ptosis repair can... Read more
Quick Key:
Show Medical Necessity for Ptosis Repair
Although each carrier may have its own LMRP outlining which diagnoses support medical nece... Read more
Uncloud Your Intraocular Lens Coding
Coding IOL procedures can be tricky - and errors can cost you more than $800If your ophtha... Read more
Reader Question:
Unlisted-Procedure Code, Orbitotomy May Suffice for Globe Exploration
Question: A patient was in an auto accident with airbag injury to both eyes. In the hospit... Read more
Reader Question:
Exophthalmometry Included in Eye Codes
Question: Is there a CPT code for exophthalmometry?Georgia Subscriber Answer: CPT consider... Read more
Reader Question:
Slick Coding for Silicon Oil Removal
Question: Our ophthalmologist examined a patient who had recently had retinal repair and h... Read more
Reader Question:
Keep Modifiers Straight for Pachymetry
Question: My doctor just started performing corneal pachymetries. When billing an eye exam... Read more
Reader Question:
Don't Cry Over Cryotherapy Codes
Question: My ophthalmologist is doing removal of a malignant conjunctival growth in the ho... Read more
You Be the Coder:
Foreign Bodies in Cornea and Conjunctiva
Question: A patient had foreign bodies in her left eye, in both the cornea and conjuncti... Read more
Avoid Irritation While Coding Epilation for Trichiasis
Confusion about coding 67820 and 67825 can be a thing of the past if you can keep up wit... Read more
Quick Key:
Lash Out With These ICD-9 Codes
Regardless of how you code epilation, you must document an ICD-9 code that signals to Medi... Read more
NCCI 10.2 Update:
CMS Increases Retrobulbar Injection, Lidocaine Bundles
Watch out: 67500 is now bundled into all but 16 eye codes The latest National Correct Codi... Read more
Show Medical Necessity for Fundus Photography
Many carriers will accept the ICD-9 codes below as diagnoses that demonstrate the medical ... Read more
Reporting Related Codes? Use Modifiers -59, -51 to Keep Claims Clear
Modifier -59 is for procedures you don't normally report together When a patient requires ... Read more
YOU BE THE EXPERT:
Slit Lamp Photos and Gonioscopies
Question: Our ophthalmologist saw a glaucoma patient and performed a gonioscopy. The opht... Read more
Reader Question:
Suture Removal Claims Won't Suit Your Carrier
Question: Medicare no longer accepts the CPT code that we have used for years for a laser... Read more
Reader Question:
Take 1 Eye Code and 1 Special Services Code, Mix Freely
Question: Can the special ophthalmological services be provided and reported with the gen... Read more
Reader Question:
Locate Dislocated Lens Dx Codes for IOL Insertion
Question: What diagnosis codes can we report for procedure code 66985? Delaware Subscribe... Read more
Reader Question:
Check CPT for Modifier -51 Exemptions
Question: Do I have to use modifier -51 every time I code a visit in which the ophthalmol... Read more
You Be the Coder:
Cataract Removal Including Vitrectomy
Question: Lately, I've been getting denials for 66984 (Extracapsular cataract removal wit... Read more
Don't Be Vague When Coding Nonspecific Complaints
Knowing the right codes to report for blurry vision can save your practice from costly den... Read more
Weigh Pros and Cons of VF Codes for Glaucoma Suspects
Misusing modifiers or dx codes could mean denials for visual field exams Ophthalmologists ... Read more
5 Simple Rules for Coding OCT
Knowing the right codes for OCT can save your office $40 per service If you're getting den... Read more
Reader Question:
Sort Out Referrals and Consults
Question: Can an ophthalmologist bill for a written report to the patient's physician who... Read more
Reader Question:
Liability Insurance:It's Worth Asking About
Question: I've heard a lot of talk recently about biller and coder liability insurance. W... Read more
Reader Question:
Keep Steady Nerves When Coding for Botox
Question: How should I code for Botox injections to control blepharospasm? Idaho Subscrib... Read more
Reader Question:
Watch Out for Workers'Comp Idiosyncrasies
Question: Our office sees a lot of workers'comp claims, usually for things like foreign-b... Read more
You Be the Coder:
Show Medical Necessity Before Considering -53
Question: Our ophthalmologist was performing a bilateral iridotomy on a patient. The doct... Read more
Test Yourself:
Would You Append Modifier -25?
These 3 common ophthalmology scenarios clear up when you can -- and can't -- separately re... Read more
Cover All Your Documentation Bases for a Payment Home Run
Before you file a claim with modifier -25 appended to the E/M service with the procedure f... Read more
News You Can Use:
Say Goodbye to Your Coding Grace Periods
Tip: Review CMS' Web site to update charge forms CMS has scrapped the 90-day grace period ... Read more
4 Pointers Make 'Add-On' Codes Easy
Don't accept payment reductions, or you could lose up to 50% on every claim When you repor... Read more
Work Well With Others With -54
Know Medicare's rules on modifiers to get fair payment for co-managed care Ophthalmologist... Read more
Reader Question:
Remove Obstacles to FB Coding
Question: Is it appropriate to code an office visit with foreign-body removal? We usually ... Read more
Reader Question:
Use -24 to Separate Similar Diagnoses
Question: Our doctor did a YAG laser surgery on a patient's right eye. We submitted a clai... Read more
You Be The Coder:
Take Pressure Off Trabeculectomy With Modifier
Question: A patient came to the office presenting with bilateral closure glaucoma, more se... Read more
Not Getting Paid for Contact Prescriptions? You Will After You Read This
92310 won't cut it - this strategy for keratoconus and aphakia patients will You know you ... Read more
Know Your Carrier's Contact Lens Policy
Here's what Medicare will - and won't - cover, and what you can expect from private carrie... Read more
Wave PTK Denials Goodbye With These 2 Codes
An S code beats an unlisted-procedure code for reporting corneal laser surgery Look all yo... Read more
Get Paid for Glaucoma Screenings for Low-Risk Patients
Proper G-modifier use unlocks otherwise denied reimbursement When your office performs a s... Read more
News You Can Use:
Medicare Nearly Doubles A-Scan Pay
CMS' fee schedule update increases reimbursement for several ophthalmic proceduresIf Medic... Read more
6 Must-Have HIPAA Training Skills
You can have all the HIPAA training in the world, but if you're not enforcing and practici... Read more
Fax and E-Mail Confidentiality Disclaimer
Providers who fax or e-mail protected health information should place disclaimers in their... Read more
Reader Question:
Wake Up to Proper Coding For Exam Under Anesthesia
Question: My doctor saw a 4-year-old in the emergency department (ED) on Friday and did a ... Read more
Reader Question:
Buckle Down on Scleral Buckle Coding
Question: We repaired a patient's detached retina with a scleral buckle. The patient later... Read more
Reader Question:
Prove Extra Effort When Reporting Difficult Vitrectomy
Question: How can we get paid more for a vitrectomy with membrane peeling, especially when... Read more
Reader Question:
Save Yourself Construction Costs
Question: Are physical barriers available to prevent patients and visitors from viewing co... Read more
You Be The Coder:
Understand Surgically Induced Versus Pre-Existing Astigmatism
Question: After cataract surgery, one of our Medicare patients developed severe astigmatis... Read more
Plug Up Leaky 68761 Reimbursement With This Expert Strategy
Hint: Modifier -50 won't get all 2-plug claims paidModifiers pose the greatest difficulty ... Read more
Don't Let Global Period Stop Payment for Plug Insertion
Rely on documentation and modifier -58 for permanent implant paymentIf you insert permanen... Read more
End Discontinued Procedures Difficulty With These Tips
Stop modifier -53 problems before they start with thorough documentationModifier -53 (Disc... Read more
Reader Question:
Sew Up Reimbursement for Conjunctival Repair
Question: My ophthalmologist removed a conjunctival lesion. To repair the conjunctiva post... Read more
Reader Question:
Link 362.83 to Focal Laser Treatment Code
Question: One of our patients with background diabetic retinopathy (BDR) presented with a ... Read more
Reader Question:
Eliminate Questions on Confirmatory Consults
Question: We saw a patient from another practice whose insurer requested a second opinion ... Read more
Reader Question:
Take the Pressure Off Glaucoma Diagnosis Coding
Question: A patient presents with high intraocular pressure, a symptom of glaucoma, and th... Read more
Reader Question:
Pluck Out Payment for Trichiasis Epilation
Question: An ophthalmologist in our practice performed an epilation for trichiasis, removi... Read more
You Be The Coder:
Muscle In on Strabismus Surgery Reimbursement
Question: What is the proper way to code when the same procedure -- strabismus surger... Read more
Aqueous Shunt Coding 101:
Report 66180 for Drainage Device
Don't let post-op procedures, materials complicate coding Less common than typical glaucom... Read more
Quick Key:
New NCCI Edits Bundle
Reference these new ophthalmologybundles to ensure clean claims The National Correct Codin... Read more
Use These NCCI 10.0 Edits
The following ophthalmology-related bundles are effective Jan. 1 through March 31, 2004.... Read more
Focus on -LT, -RT and -TC Modifiers for A-Scans
Watch out for inconsistencies among your carriers A-scans are some of the most common pro... Read more
Reader Question:
Lift the Lid on Blepharoplasty Coding
Question: Our ophthalmologist performed a blepharoplasty for a Medicare patient. We told h... Read more
Reader Question:
Take Pressure Off Negative Glaucoma Screening
Question: A patient referred to our office had high intraocular pressure, and the ophthalm... Read more
Reader Question:
Uncomplicate Clouded Cataract Coding
Question: During the postoperative period for cataract surgery on the left eye, one of our... Read more
Reader Question:
Don't Get Too Attached to Modifier -58
Question: One of our ophthalmologists performed a retinal detachment repair (67107), and j... Read more
Reader Question:
Get the Red Out on Foreign-Body Dx Codes
Question: A 16-year-old boy presented with a scratchy sensation from a foreign body in his... Read more
Reader Question:
Know the ABCs of ABNs
Question: We do lots of pachymetry procedures that are rejected by Medicare, so we have ou... Read more
You Be the Coder:
Prove Medical Necessity for Blepharoplasty
Question: Parents brought in a 4-year-old patient referral presenting with ptosis of the r... Read more
Afraid of Rejection?:
Ferret Out These 5 Common Coding Errors
And learn how to avoid them Do your physicians know to accurately link the diagnoses l... Read more
Use Modifiers -26 and -TC for New Corneal Pachymetry Code
Avert new code confusion Code 76514 has replaced Category III code 0025T in 2004 for pachy... Read more
News Brief:
Expect a 1.5% Increase in Reimbursements in 2004
Slated 4.5% cut averted by new Medicare bill CMS offered ophthalmologists an early holiday... Read more
Restructure Appeals With These 6 Steps
Get organized for easier, more productive appeals When your practice receives a denia... Read more
Read EOBs Before Responding to Denials
What 'noncovered service' really means to your office You can't streamline... Read more
You Be the Expert:
What Makes a Clean Claim?
Question: We are having problems in our family  practice with the number of claims ... Read more
Reader Question:
Know Your Limits
Question: Are there limits regarding how often I should use office visit codes for my pati... Read more
Reader Question:
Clearing Up IOL Coding
Question: We have a patient who has Myopia that could not be corrected with glasses, and h... Read more
Reader Question:
Track II Codes for Quality of Care
Question: What is the new Category II section in CPT, and how do we use it?  &nb... Read more
Reader Question:
The First Cut Is the Deepest: Postsurgery Astigmatism
Question: A patient presented with astigmatism follow-ing corneal transplant surgery. How ... Read more
Reader Question:
Keep Strabismus Coding Straight
Question: A patient presented with alternating esotropia (378.05). The ophthalmologist per... Read more
You Be the Coder:
Refraction for Medicare Patient
Question: Should I charge a Medicare patient for a refraction (92015)?   &n... Read more
Available Years:  2004  2003  2002  2001  2000  1999  1998