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Ophthalmology and Optometry Coding Alert

CPT 2007 UPDATE ~ Go With the Flow to Determine 'New' vs. 'Established' Patient Status
Even if the patient has been to your office before, he might be 'new' Proper coding for va... Read more
CLIP & SAVE ~ Here's the Quick Way to Find Out if the Patient Is New
Answer the new-vs.-established question correctly every time with this tool Take the Amer... Read more
QUICK QUIZ ~ How Much Do You Really Know About Using V Codes?
Test your diagnosis coding knowledge with these 4 questions If you think V codes are only ... Read more
BREAKING NEWS ~ Brace Yourself for a Bumpy January
Good news: Expect a boost in E/M reimbursement despite blanket cuts Your Medicare reimburs... Read more
DID YOU KNOW? ~ Avoid Using 67350 Starting Jan. 1
CMS replaces 67350 with a new biopsy code Beginning Jan. 1, if you report 67350 (Biopsy of... Read more
READER QUESTION ~ Avoid Bilateral Modifiers on 76519, 92136
Question: My ophthalmologist calculated IOL power in both a patient's eyes. Should I repor... Read more
READER QUESTION ~ Be Cautious With Modifier 25
Question: When a patient with a foreign body or chalazion comes in as a referral from anot... Read more
YOU BE THE CODER ~ Reporting Indocyanine-Green Dye Procedures
Question: One of our physicians wants to know if we can bill for indocyanine-green dye. He... Read more
2007 Fee Schedule Update:
Prepare for a Painful 5.1% Pay Cut Next Year if CMS Has Its Way
There's still hope that Congress may step in as in years pastIf CMS' proposed Medicare pay... Read more
Refrain From Choosing E/M Codes Based on RVUs
Report general ophthalmologic codes when they best describe the serviceWhen your ophthalmo... Read more
Clip & Save ~ Ensure That Your E/M Documentation Measures Up
Use these handy definitions to determine if an E/M or eye code is more appropriateWhen you... Read more
Reader Question ~ Watch Fee Schedule for Bilateral Guidance
Question: One of our ophthalmologists performed a bilateral nasolacrimal duct probe. Can I... Read more
Reader Question ~ Get a Grip on Teaching-Physician Regulations
Question: My physicians work at a teaching hospital. What should I look for in the do... Read more
Reader Question ~ ABNs Can Protect Practice With Private Payers, Too
Question: Are there any waivers for use when the physician provides a noncovered service t... Read more
Reader Question ~ Hospice Care Calls for GV or GW
Question: We have a new ophthalmologist in our practice who is going to be seeing hospice ... Read more
Reader Question ~ Never Use E Codes as Primary
Question: I've never really understood E codes andwhen I should use them. Would you explai... Read more
You Be the Coder ~ Coding Admission and Discharge Within Hours
Question: My ophthalmologist treated a 2-year-old patient who was in an automobile acciden... Read more
Capitalize On These Opportunities to Avoid 92135 Denials
Experts answer your top SLGT coding questions Ophthalmologists are beginning to use scann... Read more
MEDICARE UPDATE ~ Take These Steps to Avoid Growing Consult Confusion
You aren't responsible for the requesting physician's files, CMS says Recent Medicare rule... Read more
Familiarize Yourself With The Various SLGTs
Knowing what terminology to look for will help your coding To correctly code and bill for ... Read more
Back to Basics ~ Solidify Your Diagnosis Skills Before the 2007 Codes Appear
Make sure you know how to apply V codes Choosing the right CPT procedure code is the first... Read more
CORRECTION ~ List 67038 Before 67108
Our September 2006 issue included an error in the You Be the Coder answer "Tractional Reti... Read more
Don't Forget to Add These New ICD-9 Codes to Your Arsenal
New diagnosis codes can help prove medical necessity In the June 2006 issue of Ophthalmolo... Read more
Reader Question ~ Use 99201-99205 if Patient Switches to Your Office
Use CPT 99201 -99205 if Patient Switches to Your Office Question: When my ophthalmologis... Read more
Reader Question ~ Code Blepharoplsty First in ASC
Code Blepharoplasty First in ASC Question: Our oculoplastic surgeon performed levator rese... Read more
Reader Question ~ Choose Category III Code for TCF
Choose Category III Code for TCF Question: My ophthalmologist performed a procedure he des... Read more
Reader Question ~ Factor Location Into Payment Calculations
Factor Location Into Payment Calculations Question: How can I figure out what a procedure ... Read more
You Be the Coder ~ Foreign-Body Removal
Question: A patient with glass in her cornea came into our office. The ophthalmologist rem... Read more
Jump on J Code for Lucentis Payment
The FDA just approved the drug to treat AMD--read these tips to get ready to incorporate... Read more
Check Carrier Rules For Avastin Coding
Medicare may allow the treatment for AMD, even without FDA approvalYou may be able to star... Read more
Don't Miss Out On Extended-Hours Payments
Your point of service determines which 2006 CPT codes are right for youWhen you offer serv... Read more
Clip and Save:
Keep 2006 CPT Extended-Hours Code Changes at Your Fingertips
Use our handy chart to find the right code change in a flashSpecial service codes won't be... Read more
READER QUESTIONS:
Use E/M Code for Toxicity Exam
Question: One of our patients was told by her doctor to see an eye doctor annually because... Read more
READER QUESTIONS:
Don't Try Low-Vision Codes on Medicare
Question: Our practice is considering dispensing low-vision aids. How should we code those... Read more
READER QUESTIONS:
Could a New Problem Be a Consult Opportunity?
Question: A patient originally came to our office based on a referral for a procedure. The... Read more
READER QUESTIONS:
Find Medicare LCD in 1 Stop
Question: Where can I go to look up Medicare carriers' local coverage determinations? Also... Read more
You Be the Coder:
Tractional Retinal Detachment
Question: The surgeon performed a pars plana vitrectomy with epiretinal membrane peeling. ... Read more
News You Can Use:
Got IOL Questions? Find Your Answers Here
CMS clarifies its P-C IOL policy, and grants NTIOL status to the AcrySof IQYou already kno... Read more
Reporting Each Foreign-Body Removal Separately? Not So Fast
FB removal coding depends on the site--and sometimes on the whims of the carrierIf a patie... Read more
Payment Update:
Work RVUs for Level-3 Office Visits Set for 37 Percent Hike
Everything changes starting next January--will you be ready?Good news: Your payments for e... Read more
New Patient Visits:
Same Group, Different Specialty--Collect What You Deserve
Stand your ground when a carrier shoots you down on new patient visitsWatch out: It's time... Read more
READER QUESTIONS:
Take Your ROS Up a Notch
Question: What are the differences among the "review of systems" levels for the E/M codes?... Read more
READER QUESTIONS:
Forget 'New Vs. Established' for Office Consults
Question: Should I report a consult for an established patient (whom we last saw two years... Read more
READER QUESTIONS:
Stay on Top of Topography Codes
Question: What is the correct Medicare code for corneal topography? We used 92499 and were... Read more
READER QUESTIONS:
Count Prescriptions as Part of E/M
Question: My ophthalmologist heard that there's a code we can bill and be paid on just for... Read more
READER QUESTIONS:
How to Find the Right HCPCS Jurisdiction
Question: Is there any guidance on whether to report HCPCS codes to our DMERC or local ca... Read more
You Be the Coder:
Partial Cataract Extraction
Question: We took a patient in for cataract surgery and IOL insertion, and ended up not fi... Read more
Myth Buster:
Earn Full Pay for Pre-Cataract Surgery Tests With Bulletproof Bilateral Coding
Improperly coding IOL Masters or A-scans can cost your practice $30 per patient Calculatin... Read more
Reject 366 for Your IOL Master Claims Before Medicare Does
To prove medical necessity, you must get specific -- or risk denials Medicare covers IOL c... Read more
News You Can Use:
Prepare Now for Modifier 25 Crackdown
The different-diagnoses stipulation may not apply to E/Ms and minor procedures If you&... Read more
Save $100 With These 3 Modifier 25 Tips
Submit separate and significant E/M and procedure documentation CMS is paying more attent... Read more
Reader Questions:
Base Levator Code on Approach
Question: What is the correct code for a levator resection to repair blepharoptosis?Califo... Read more
Reader Questions:
Master Medicare Supervision Levels
Question: Would you explain the “physician supervision of diagnostic services&rdqu... Read more
Reader Questions:
Check Both Surgeons' Notes on Modifier 62 Claims
Question: Our ophthalmologist recently performed a pars plana lensectomy and posterior vit... Read more
Reader Questions:
Code After-Hours Emergency With 99050
Question: The ophthalmologist returned to the office at midnight to see a patient with an ... Read more
You Be the Coder:
Giant Papillary Conjunctivitis
Question: I'm trying to find a diagnosis code for giant papillary conjunctivitis. Since I ... Read more
CD-9 2007 Update:
Using 997.99 to Report Bleb Infection?
New diagnosis codes include stages of post-trabeculectomy inflammations -- and a new ... Read more
Quick Quiz:
Keep Your Cataract Modifiers Straight -- or Risk $900
Appending the wrong modifier may torpedo your claims Ophthalmology coders are likely to co... Read more
News You Can Use:
Earn $50 More for Tecnis IOLs In An ASC With This New Code
Medicare will pay extra for the new-technology IOLs for the next 5 years Ambulatory surger... Read more
Don't Code Another High-Level E/M Claim Until You Read This
Protect yourself from carrier audits with these handy tips Watch out: Carriers are looking... Read more
Check Your E/M Frequency Against National Statistics
If your distribution looks much different, you could be raising a red flagA thorough inter... Read more
Reader Questions:
Append 2 Modifiers for 2 Bundles
Question: A patient came in during the global period for a procedure on her left eye with ... Read more
Reader Questions:
Use 2 Lines for Bifocal Coding
Question: How would I go about coding for a progressive bifocal to those plans that pay fo... Read more
Reader Questions:
Report 65210 for Concretions
Question: I need a CPT code for removal of conjunctival concretions. The ophthalmologist f... Read more
Reader Questions:
Any Doctor Can Use ED Codes
Question: An emergency department physician asked our ophthalmic surgeon to see a patient ... Read more
Reader Questions:
Base Lid Repair Code on Thickness
Question: Our ophthalmologist took a patient into the OR for repair of lid laceration and ... Read more
Reader Questions:
Keep POS Straight for Rest Homes and Private Homes
Question: Our ophthalmologist saw a patient for a brief visit in her home. I coded 99321 (... Read more
You Be the Coder:
Diurnal Curve Testing
Question: Is there a code for "diurnal curve testing," in which the ophthalmologist checks... Read more
NCCI 12.1 Update:
Chill Your Hopes of Coding Moderate Sedation With Cyclocryotherapy
New National Correct Coding Initiative edits also bundle 99143-99144 into most E/M codesBa... Read more
Master Eyelid Modifiers for Chalazions and Epilations
Code by eye or by eyelid?  CPT rules help--but carriers have the final answerA patien... Read more
Modify Wisely to Earn $280 More For Bilateral Entropion Repairs
Tip:  If the code definition includes 'upper' or 'lower,' omit E1-E... Read more
News You Can Use:
Prepare for a New Crackdown On Consult Coding
Learn how a simple fax can keep you compliant with documentation rulesNow's the time to re... Read more
READER QUESTIONS:
Don't Confuse PAM With VEP
Question: Is 95930 the correct procedure code for potential visual acuity meter? Can this ... Read more
READER QUESTIONS:
Count Wasted Botox on Last Patient's Claim
Question: Our practice is using Botox to treat strabismus. I think we should use 67345, bu... Read more
READER QUESTIONS:
Count Global Days Before Appending 57
Question: A patient presents with an eyelid lesion, which the ophthalmologist excised. Aet... Read more
READER QUESTIONS:
Include Schirmer's Test in Exam
Question: Is there a code for a Schirmer's tear test other then the generic 92499? I have ... Read more
READER QUESTIONS:
Nonphysician Staff Can Perform History Element
Question: Must the ophthalmologist take a patient's history, or can a tech or other nonphy... Read more
You Be the Coder:
FP for Diabetic Patient
Question: We submitted a claim for 99204 and 92250 to Medicare. The diagnosis code for bot... Read more
Renovate Your Coding for Successful Corneal Remodeling Reimbursement
Don't give up on AK payments if you can prove that astigmatism is surgically induced If yo... Read more
CPT Update:
Catch This Error in Manual's E/M Instructions
Don't let AMA's typos trick you into reporting the wrong 'new patient' codes If you're usi... Read more
Don't Lose Out on Postsurgical Complications Payments
If you're treating Medicare and private payers the same, you're losing payments If you're ... Read more
News You Can Use:
Add Hispanics 65 and Older To Glaucoma Screening Benefit
Now 4 at-risk groups qualify for G0117 In 2006, you need to ask one more question to deter... Read more
OIG Alert:
Reserve Modifier 25 For Separate E/M HEM
Only reporting one code? Hold the modifiers! In a recent study, the Office of Inspector Ge... Read more
Reader Questions:
Opt for 65780 for Amniotic Membrane Graft
Question: The ophthalmologist wants to perform a pterygium excision with anmiotic membrane... Read more
Reader Questions:
Include Evaluation With Scheduled Focal Laser
Question: The retinologist meets with a patient and recommends a focal laser treatment, wh... Read more
Reader Questions:
Save S0800 for Non-Medicare Carriers
Question: What code should we use for LASIK?North Dakota Subscriber Answer: Because there ... Read more
Reader Questions:
Observation Status Is Outpatient
Question: When providing a consult for a patient admitted to observation, should we report... Read more
Reader Questions:
Satisfy New Consult Criteria With a Fax
Question: To use a consultation code, a coworker thinks we should make sure the requesting... Read more
You Be the Coder:
Baerveldt Implant
Question: Which CPT code should I report for a Baerveldt implant?Ohio SubscriberAnswer: Re... Read more
Follow 3 Tips for Exemplary Extended Ophthalmoscopy Coding
Understanding the difference between EO and routine ophthalmoscopy is the key to avoiding ... Read more
News You Can Use:
Code for Vision Rehab Thanks To Demonstration Program
CMS tests the waters for full low-vision rehabilitation reimbursement If your practice inc... Read more
OIG Alert:
Audit-Proof Your Modifier 59 Claims With This Strategy
Don't be one of the 40 percent of claimants who misuse the modifier An ophthalmologist in... Read more
Reader Questions:
'Waste Not' Unused Drug Portion
Question: One of our patients had an allergic reaction to a drug, causing us to waste near... Read more
Reader Questions:
Report 11900 for 7 Lesions or Fewer
Question: One of our ophthalmologists did an intra-lesional steroid injection on the right... Read more
Reader Questions:
Look to New HCPCS Code for Retisert
Question: Our ophthalmologists are considering using Retisert implants. What is Retisert a... Read more
Reader Questions:
Report Services Regardless of Expected Payment
Question: Should we report exactly the same group of codes to all payers, or can we submit... Read more
Reader Questions:
Focus on 66985 for Secondary Implant
Question: A patient is going to have a secondary IOL implant. Is 66985 the right code? Wha... Read more
Reader Questions:
Append 26 for VF Interpretation
Question: We did a visual field at the request of a primary-care physician for a patient w... Read more
You Be the Coder:
Epilation and E/M During YAG Global
Question: One of our patients is still in the global period for a YAG laser procedure. S... Read more
NCCI 12.0 Update:
Include Intravitreal Injections in Scleral Buckling
Make sure your documentation justifies separate services If you regularly code intravitrea... Read more
Crack These Confounding Cataract Coding Conundrums
Surgery on both eyes on different dates means 2 global periods to deal withOphthalmology c... Read more
Consult CMS' Checklist for Confident E/M Coding
After 3 years, faces familiar to your ophthalmology practices are new againIf a patient yo... Read more
Relax--Rest Home Coding Is Easier Than You Think
'Lack of medical component' distinquishes POS 33An ophthalmologist in your practice visits... Read more
READER QUESTIONS:
Track Disease Progress With 92285
Question: We saw a patient after a scleral buckle procedure by another surgeon. The patien... Read more
READER QUESTIONS:
Report 69990 With Caution
Question: What are the requirements for reporting the operating microscope (69990)? It see... Read more
READER QUESTIONS:
Hang Up Hopes for 99373-99373 Payments
Question: I noticed that CPT has codes for telephone calls. Should I be using them to repo... Read more
READER QUESTIONS:
Sniff Out Excluded Services for SNFs
Question: We performed a test on a patient in a SNF, and Medicare denied it, saying that t... Read more
READER QUESTIONS:
Don't Count on Cash for Education
Question: Is there a way we can offset the cost of educational materials, pamphlets, etc.,... Read more
You Be the Coder:
Cross the Vast Avastin Coverage Gap
Question: We've started using Avastin to treat AMD. Is the coding for this any different t... Read more
Nail Strabismus Surgery Coding Every Time With Foolproof Anatomy Knowledge
How many muscles?  Horizontal or vertical?  The answers will keep your coding fr... Read more
Reporting 378.21 for Pseudo-Strabismus? Read This First
Esotropia doesn't fully describe the condition--an eyelid code is a better betA child appe... Read more
News You Can Use:
Report This New HCPCS Code For IOL Presbyopia Function
Medicare provides a code for the supply, but the beneficiary must still payIf your ophthal... Read more
Keep Your E/M Modifiers Straight With These Simple Tips
Assign 57, not 25, for E/M prior to a major surgical procedureModifiers 24, 25 and 57 all ... Read more
READER QUESTIONS:
Check Local Rules for 367.9 Coverage
Question: Will Medicare reimburse for 92004 or 92014 with the diagnosis code 367.9? ... Read more
Coding For Success:
Maximizing E/M Revenue
Presented by:  Jim Collins, CPC, CHCC The following supplement to Radiology Codi... Read more
READER QUESTIONS:
Charge Outpatient Consult for Observation
Question: A doctor asked my ophthalmologist for a consult with a patient who had been admi... Read more
READER QUESTIONS:
Omit Modifiers for Incident-To Services
Question: Should I use a modifier when reporting services provided incident-to the ophthal... Read more
READER QUESTIONS:
Let Provider Steer Hospice Modifier
Question: When an ophthalmologist who is a non-hospice provider performs a medical visit a... Read more
You Be the Coder:
Learn the Trick to Distichiasis Coding
Question: I am unable to find a diagnosis code for distichiasis. The patient had an eyelas... Read more
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