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Ophthalmology and Optometry Coding Alert

CPT® 2013:
Watch For Anterior Segment Photography, Paracentesis Changes
Use the same code for diagnostic and therapeutic paracentesis with removal of aqueou... Read more
Evaluations:
Determine the Difference Between Intermediate and Comprehensive Exams
Other options include E/M and S-codes, but choose wisely. CPT® divides general ophth... Read more
Retinal Surgery:
Choosing Wisely Between 67108 or 67112 Can Mean $277 to Your Practice
Follow these tips for airtight recurrent retinal repair coding. Two retinal repair codes... Read more
Reader Question:
365 Alone Won't Cut It as Visual Fields Dx
Question:  We keep getting denials for 92082 and 92083 (Visual field examination ...) ... Read more
Reader Question:
92226 Requires Proof EO Is Actually Extended
Question: I just got a denial on 92226. I think I might be using this code incorrectly... Read more
Reader Question:
Look to 66986 for IOL Exchange
Question: What code should I use to report when the ophthalmologist replaces an intraocul... Read more
Reader Question:
Stick to V2521 for Astigmatic Contacts
Question: Which code should we use for monthly replacement toric contacts? We have bee... Read more
You Be the Coder:
EOM Function Test
Question:  My ophthalmologist wants to code for a "detailed evaluation of EOM functio... Read more
CCI Update:
Include Skin Repair With Most Eye Surgeries
The latest Correct Coding Initiative update includes over 230,000 new edit pairs. Ever... Read more
Diagnostic Tests:
92133 Basics: Avoid These Pitfalls and Keep OCT Coding on Track
Documentation, modifiers, and knowing your bundling rules can be worth nearly $45 each tim... Read more
Compliance:
OIG to Focus on E/M, Incident-To, and Global Modifiers in 2013
Plus: You'll also see extra scrutiny on ophthalmology claims, among others. The HHS Office... Read more
News You Can Use:
Double-Digit Cuts May Strike Your Income Starting in January
Some specialties will be hit hard, unless Congress steps inEvery year around this time, th... Read more
CPT® 2013:
Get the Scoop on E/M Verbiage Tweaks Coming in the New Year
The good news: Code descriptor changes won't really change your billing.Most practices bil... Read more
Reader Question:
ICD-9 Freeze Will Spare You New Updates This Year
Question: Are there any ICD-9-CM updates planned for 2013? Iowa Subscriber Answer:&nb... Read more
Reader Question:
Document Problem for Post-Op Exam
Question: We did a general eye exam at the patient's request within the three-month period... Read more
Reader Question:
65210 a Solid Choice for Conjunctival Concretions
Question: I need a CPT® code for removal of conjunctival concretions. The ophthalmol... Read more
Reader Question:
Stick to 67028 for Kenalog Injections in Office
Question: I code for a group of ophthalmologists in a university hospital. When an ophthal... Read more
You Be the Coder:
Multiple Canal Probes
Question: I need some help with CPT® code 68840. Is this billed bilaterally, with mo... Read more
Diagnostics:
Reporting 92100 or 92225 Bilaterally? Read This First
Modifiers are they key that can, in some cases, unlock double the reimbursement. Most ... Read more
Punctal Plugs:
Fight Back Punctal Plug Denials With These 4 Steps
Hint: Make sure to check your documentation and the payer's policy.You've coded what you'r... Read more
E/M Corner:
3 Steps Lead to MDM Determination Success
Follow our experts' system to calculate each individual piece of the medical decision maki... Read more
Reader Question:
92012 or 92014?
Question: When is it appropriate to use 92012 as opposed to 92014?Virginia SubscriberAnswe... Read more
Reader Question:
Be Sure to Send Overpayments Back to Insurer
Question: I just recently went to a seminar and the instructor informed us that we should ... Read more
Reader Question:
Report Unrelated Fundus Photos Without Modifier
Question: We have a patient still in the global postoperative period for cataract surgery.... Read more
Reader Question:
92015-92140 and 92002-92014 Can Mix
Question: Can the special ophthalmological services be provided and reported with the gene... Read more
You Be the Coder:
Epilation of Lashes
Question: What is the proper way to code for epilation of lashes? We used to bill per la... Read more
CPT:
92310-92313 Guide: Achieve Contact Lens Clarity With Expert Advice
Tip: If a tech does the fitting, your coding strategy changes. Experienced ophthalmolo... Read more
AMD:
362.51 or 362.52? Diagnosis Depends on Type of Macular Degeneration
Follow 3 tips to keep your coding correct. Approximately 10 percent of patients 66 to 74 ... Read more
Global Periods:
'XXX'? 'YYY'? Make Sense of the Global Alphabet Soup
Hint: Major and minor procedures differ in days of postop care. Ignoring global period... Read more
ICD-10 Outlook:
AMA and Provider Feedback Impact ICD-10 Delay
Don't let changes catch your ophthalmology practice by surprise. CMS hasn't made a final ... Read more
Reader Question:
Nursing Home Patient -- Eye or E/M Code?
Question: I visited a patient who was in a nursing home. Should I use an eye exam code or... Read more
Reader Question:
Append 58 to Excision After Incision
Question: The ophthalmologist incised a patient's conjunctival cyst (68020). One week lat... Read more
You Be the Coder:
Refraction for Medicare Patient
Question: A Medicare patient came in just to have his prescription updated. If I onl... Read more
CCI 18.2 Update:
65778-65779 Bundles: Be Careful When Reporting Amniotic Membrane Placement With These Codes
Also: Take note of these changes to your transluminal dilation coding.If your cornea speci... Read more
Healthcare Reform:
Affordable Care Act Already Having Effect
Our expert weighs in with her views.In the wake of the U.S. Supreme Court's ruling upholdi... Read more
Denial Management:
Avoid Claim Rejections by Checking Practitioner Specialty Code
Plus: Medicare's one-year payment window causing massive headaches. If you report ... Read more
Compliance:
Scrutinize Your E/M Level Trends Before Your Payers Do
Are you part of the increase in 99214 and 99215 frequency?If you examine your practice's E... Read more
Reader Question:
V67.00 Accurately Describes Follow-Up After Surgery
Question: If a patient receives treatment and the condition was resolved, which ICD-9 code... Read more
Reader Question:
67904 and 15823: Code Levator Resection First
Question: Our oculoplastic surgeon performed levator resection and blepharoplasty on both ... Read more
Reader Question:
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 Question:
Catch Up on Incomplete Claims
Question: Our practice has a few claims that have missing or incorrect information. I'm no... Read more
You Be the Coder:
PAM or VEP?
Question: Is 95930 the correct procedure code for potential visual acuity meter? Can this ... Read more
Diagnostics:
92250 Strategies: 5 Tips Help You Snap Up Rightful Fundus Photo Pay
Don't overdo the diagnosis codes, experts warn. Fundus photography is a critical tool in y... Read more
E/M Coding:
Translate the Alphabet Soup of E/M Coding With These 5 FAQs
From HPI to PMFSH, we've got the scoop on E/M coding.Part B MACs plan to scrutinize your e... Read more
Audits:
Prepare Your Practice for 5 Common Audit Types
Avoid RAC trap for bilateral surgeries. If it seems like audits are coming at your oph... Read more
Reader Question:
11900 Describes Chalazion Treatments With Kenalog
Question: How should I report treatments for chalazions? Pennsylvania Subscriber ... Read more
Reader Question:
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
You Be the Coder:
Levator Repair
Question: What is the correct code for a levator resection with an external approach to re... Read more
Eye Exams:
92004 and 92014: Can You Code Comprehensive Exams Without Dilation?
You can bill for a second visit for a patient refusing dilation if you know these coding t... Read more
Eye Allergies:
373.0, 375.15, or 372? Get Specifics on Eye Irritation to Find Best Dx Code
Scratch that spring allergy coding itch with this expert advice.Spring is here, which mean... Read more
Diagnosis Coding:
CMS Proposes 1-Year Delay for ICD-10
Don't count on the delay quite yet, coding expert warns.Ophthalmology practices have been ... Read more
News You Can Use:
CMS Extends 5010 Compliance Period
Bad news: Technical glitches are still causing problems.Practices that were sweating the A... Read more
Reader Question:
76514 Suffices for Bilateral Pachymetry
Question: I'm trying to submit a claim for 76514 performed on both eyes, but I've been get... Read more
Reader Question:
379.31 Proves Necessity for V2219
Question: I'm really confused about codes V2219 and V2319 for Medicare patients. I know it... Read more
Reader Question:
Avoid J2001 for Minor In-Office Procedures
Question: Is there a code we should bill for subcutaneous lidocaine or lidocaine with epin... Read more
Reader Question:
No Documented HPI Leads to No Coding for New Patient
Question: A new patient visits the ophthalmologist with a chief complaint. I don't have a ... Read more
You Be the Coder:
Aqueous Shunt With Graft
Question: My ophthalmologist performed an aqueous shunt but added an additional step.... Read more
Oculoplastic Surgery:
67901-67908 Essentials: Protect Your $740 in Reimbursement With Proper Blepharoptosis Coding
Make sure your medical necessity and surgical approach documentation is ironclad to preven... Read more
Modifiers:
3 Tips Distinguish 58 and 78 to Impact Your Bottom Line
Same condition or complication makes the difference. Choosing the appropriate global-p... Read more
DME Coding:
Providing Post-Cataract Refractive Lenses? Keep These Modifiers in Mind
KX or EY may save your V2784 or V2755 claim.If you're providing refractive lenses for cata... Read more
Reader Question:
92081-92083 x 1 Suffices for Many Pre-Bleph Exams
Question: Our doctor saw a patient for droopy eyelids, and to determine the extent to... Read more
Reader Question:
99241-99255: Keep Consults When Possible
Question: Can we still use "consult" E/M codes?North Carolina SubscriberAnswer:  The ... Read more
Reader Question:
Double Check Copay Early to Save Time, Money
Question: A patient came to our office with the same insurance card she's had for years. W... Read more
You Be the Coder:
Toxicity Follow-Ups
Question: A primary care physician instructed one of our patients to see an eye doctor ann... Read more
IOLs:
V2632 Is Just the Start -- Look to V2787 and V2788 for Multifocal IOLs
Also: Expecting extra pay for new-technology intraocular lenses? Read this first. Cataract... Read more
Extended Ophthalmoscopy:
92225-92226 Claims Success Relies on Solid Documentation
Learn what distinguishes EO from the standard ophthalmoscopy included in most eye exams.... Read more
ICD-10:
ICD-10 Date Will Be Postponed, HHS Confirms
Delay could offer practices additional time to prepare for new diagnosis coding system.Jus... Read more
HIPAA:
With Audits Heating Up, Is Your Practice Ready?
Make sure your privacy and security practices are up to date.If your HIPAA protocols fall ... Read more
Reader Question:
76529 Requires Documentation of Need for Eye Ultrasound
Question:  During surgery, the ophthalmologist performed an ultrasound of the patient... Read more
Reader Question:
92015 Hint: Append GY to Refraction Claims
Question: A doctor recently told me that appending modifier GY to the refraction code woul... Read more
Reader Question:
372.51 Nails Irritated Pinguecula Dx
Question: Which diagnosis code should I use for an irritated pinguecula?Connecticut Subscr... Read more
You Be the Coder:
Cosmetic Ptosis Repair
Question: We have a Medicare patient who will be having a levator resection on his right e... Read more
CCI 18.0 Update:
67961-67966 Includes Graft Site Preparation
Also: Watch for these new eyelid reconstruction Correct Coding Initiative edits. If your o... Read more
Part B Update:
Despite CPT® Revision, Medicare Won't Update 'New Patient' E/M Rules for 2012
Plus: Claims reprocessing has completed, so make sure your claims have been corrected. ... Read more
Fee Schedule Update:
Expect 2-Month Medicare Payment Reprieve
SGR formula fix is key.You won't face a 27 percent Medicare pay cut beginning Jan. 1 after... Read more
Workers' Compensation:
5 Guidelines Ease the Pain of Billing Workers' Compensation
If you don't get pertinent information before seeing the patient, expect trouble when you ... Read more
Reader Question:
367.9 Is Best Choice for Ametropia
Question: Which ICD-9 code should I report for ametropia? Kansas Subscriber Answer: ... Read more
Reader Question:
Collect Surgical Deductibles Up Front
Question: We often have patients who don't pay their deductible after surgery. Is there a ... Read more
You Be the Coder:
Long-Standing Strabismus
Question: Another ophthalmologist referred a new patient with long-standing strabismus t... Read more
FBR:
65205-65222 Coding Success Depends on Location, Penetration Level
Bonus: Documented embedded corneal FBRs can earn $10 more per procedure. Are you rout... Read more
Physician Fee Schedule 2012:
Brace Your Practice for 27% Medicare Conversion Factor Cut
Could a reprieve be around the corner?'Tis the season for another round of tense waiting t... Read more
Diabetic Complications:
250.00 Alone Won't Cut It for Diabetic Patients With Ophthalmic Manifestations
Hint: Make sure to code the specific diabetic Dx your ophthalmologist is providing care fo... Read more
ICD-10 Bridge
Once ICD-10 is implemented in 2013, the diagnosis codes in the above story will be differe... Read more
Reader Question:
List Referring Doctor's Name for Pachymetry
Question: I am billing pachymetry (76514, 1 unit) with a diagnosis code of 365.04 (Ocular ... Read more
Reader Question:
66985 Focuses on Secondary Implant
Question: A patient is going to have a secondary IOL implant. Is 66985 the right code? Wha... Read more
Reader Question:
Base Billing Order on RVU Order
Question: I know that as a general rule the highest RVU has a higher billed amount an... Read more
You Be the Coder:
Graft Revision
Question: After a pterygium removal, the patient's conjunctival allograft dislocated. The ... Read more
CPT® 2012 Update:
92070 For Therapeutic Contacts? Not Anymore
New codes 92071 and 92072 carry the load for lens prescriptions for keratoconus and OSD . ... Read more
ICD-10 Bridge
Once ICD-10 is implemented in 2013, the diagnosis codes in the above story will be differe... Read more
5010 Readiness:
Medicare Won't Penalize You for 5010 Non-Compliance Until March 31, 2012
Plus: Avoid PO boxes on 5010, despite what your MAC tells you.Sweating over the fact that ... Read more
Medical Necessity:
3 Steps Focus Diagnosis Coding for Your Eye Surgery Claims
Add these tips to your ICD-9 toolbox. You won't get paid for your ophthalmic surge... Read more
E/M:
HPI Know-How Helps You Catch Level 4 and 5 E/M Opportunities
Beware of CPT® and Medicare differences when counting HPI elements.Not accurately ac... Read more
Reader Question:
66821 Works Again for Repeat YAG Capsulotomy
Question: The doctor performed a YAG laser capsulotomy. Six months later, during a return ... Read more
Reader Question:
Know Your State Laws, Payer Rules Before Sending Patient to Collections
Question: I work in a physician's office handling the collection of past due copays, deduc... Read more
You Be the Coder:
Exophthalmometry
Question: Is there a CPT® code for exophthalmometry?Georgia SubscriberAnswer: CPT�... Read more
Available Years:  2012  2011  2010  2009  2008  2007  2006  2005  2004  2003  2002  2001  2000  1999  1998  

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