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Ophthalmology and Optometry Coding Alert

HCPCS Coding:
Foolproof Your J0178 Coding With These Tips
Aflibercept generated last year's highest allowed charges, CMS says. Do you assume that y... Read more
ICD-10 Coding Quiz:
Can You Answer These 5 Eye Care-Specific Diagnosis Coding Questions?
From cataracts to corneal abrasions, you should be able to code these conditions. Most ey... Read more
Medicare Basics:
Bust These 8 Medicare Myths
A MAC rep dispels several commonly-held myths about the insurance program. If you think t... Read more
Reader Question:
Use Three Details to Calculate Medicare Fees
Question: How do I determine which RVUs to use in the Medicare fee schedule so I can antic... Read more
Reader Question:
Don't Panic Over Billing Fluctuations
Question: We chart our payments, charges, adjustments, and closing accounts receivables ev... Read more
Reader Question:
Ensure That Front Desk Is Tasked With Collecting Balances
Question: We recently had a patient present for his annual vision exam and his chart had a... Read more
Reader Question:
Take These Steps When Appealing
Question: An outside consultant recently came in to review our claims. She pointed out sev... Read more
You Be the Coder:
Does One Size Fit All for Pinkeye?
Question: We have had over a dozen students come in with pinkeye over the past week becaus... Read more
CPT® 2020:
New Edition of CPT® Updates Cataract Codes
Look for both new, revised codes effective Jan. 1. The new year is quickly approaching, a... Read more
Billing:
Interested in Treating Family Members? Check This Reimbursement Advice
Tip: Medicare excludes family member treatment from payments. If your eye care physician ... Read more
E/M Coding:
Get Back to Basics With New vs. Established E/M Answers
Tip: The location of the encounter won't be the deciding factor. On the surface, if you k... Read more
Reader Question:
Take Next Step If Insurer Doesn't Pay
Question: We are having issues with one payer — they are denying all claims for glaucoma... Read more
Reader Question:
Use These Tools to Find Chief Complaint
Question: We know we can't report an E/M code without a chief complaint, but sometimes we ... Read more
Reader Question:
Give Patients Their Medical Records
Question: We had a patient ask for her medical records and we misplaced the request and fo... Read more
You Be the Coder:
Differentiate Nursing Facility Types to Determine POS
Question: We have one ophthalmologist who visits patients in nursing homes and evaluates t... Read more
Diagnostic Coding:
RACs Put SCODI Codes Under Review
Billing both of these codes together could land you in hot water. Eye care practices freq... Read more
Modifiers:
Do You Know Which Modifiers Impact Eye Care Payment?
Use this quick and easy guide to keep your reimbursement flowing. Every coder is familiar... Read more
Imaging:
Nail Down New TC, PC Billing Policy to Keep Diagnostic Claims in Check
Find out how the guidelines could impact your practice. If your eye care practice ever re... Read more
Reader Question:
Delve Into Denial Reason for 92065
Question: Our eye care clinician performed orthoptic training every two weeks for eight mo... Read more
Reader Question:
Time Is Money When It Comes to Preapprovals
Question: We recently met with a consultant who advised us how to bring up our collections... Read more
Reader Question:
Prepare an ABN When Questioning Risk in Glaucoma Screenings
Question: Our ophthalmologist will occasionally perform glaucoma screenings for patients w... Read more
You Be the Coder:
How Should You Document Teaching Physician Services?
Question: We currently have a medical student working with us at our eye care clinic. In p... Read more
ICD-10 Coding:
Look for New Orbital Fracture, Vision Screening Codes Oct. 1
ICD-10 makes over 400 changes effective this fall. When ICD-10 initially went into effect... Read more
Advance Beneficiary Notices:
Know These 10 ABN Facts Essential to Eye Care Practices
Hint: If you aren't aware of coverage guidelines, it's you who pays — not the patient. ... Read more
Compliance:
Latest OIG Report Shines Light on EHR Issues
Tip: Make sure your software is on the up and up. Health care fraud goes far beyond upcod... Read more
Reader Question:
Establish A No-Show Policy?
Question: We have never charged for no-shows, but we're starting to realize we may be... Read more
Reader Question:
Understand the Corneal Abrasion Dx Codes
Question: A new patient came in with pain, redness, and tearing in her right eye. She... Read more
Reader Question:
Check Contracts When Waiving Copays
Question: We have a few patients at our practice who aren't charged anything when the... Read more
Reader Question:
Look to G Codes for Glaucoma Screenings
Question: Our ophthalmologist keeps circling E/M codes like 99212 when he performs gl... Read more
You Be the Coder:
Go After These After-Hours Codes
Question: A patient called and said she thought she had a detached retina, and we schedule... Read more
NCCI 25.2 Edits:
Excising Eyelid Lesions? Watch When You Pair These 2 Lesion Types
Pay attention to a key exception in the excision code descriptors. Chalazia, anyone? If y... Read more
CCI Edits Basics:
What's Going on With the Columns?
Can't make heads or tails of the columns in the Correct Coding Initiative (CCI)? Understan... Read more
Coding Case Study:
Choose IOL Removal Codes Based on Portion, Approach
Watch that you don't confuse an IOL with a natural lens—or that could blur your code cho... Read more
Practice Management Clip and Save:
5-Step Process Sets Your Office Up for More Efficiency — And Profitability
Call forth your inner Sherlock and follow clues to solve hidden problems. If you could pu... Read more
Reader Question:
Select Strabismus Code by Muscle Type
Question: Our provider performed a right medial rectus disinsertion/reinsertion of the mus... Read more
Reader Question:
Do Annual Diabetic Exams Require a Copay?
Question: I always seem to have trouble when patients come in for a yearly diabetic eye ex... Read more
Reader Question:
Bundle Contact Bandages
Question: Is there a supply code for a bandage contact lens that I can bill to Medicare? D... Read more
You Be the Coder:
Identify the Right Approach, Location for Aqueous Drainage Implants
Question:  Our physician used a Xen Gel implant on a glaucoma patient. Should I bill ... Read more
Vision Care Coding:
Adjust Your Focus and Sharpen Your Posterior Segment Imaging Claims
Use Medicare's LCDs as your viewfinder for fundus photos and EO payment. When you're putt... Read more
Put These 6 FP Limitations in Close Range View
To get fundus photography claims paid via Medicare, you've got to heed these requirements,... Read more
Ocular Ultrasound:
A or B or Both? Answer This Question to Select the Right Diagnostic Ultrasound Code
Lesion details and a spike graph are your clues. Submitting perfect claims for your physi... Read more
ICD-10:
What Diagnoses Support 76510?
Drill down to assign the right condition with this refresher. Your physician will use dia... Read more
Reader Question:
Don't Code “Suspected” Abuse
Question: A patient presented at our office worried that she had a detached retina due to ... Read more
Reader Question:
Evaluate Therapeutic Contact Lens Replacement
Question: We have a patient with severe dry eye who needed replacement therapeutic contact... Read more
You Be the Coder:
Check Note Before Billing Pupillary Membrane Treatment
Question: One of our patients has pigmented pupillary membrane and has never had cataract ... Read more
ICD-10:
Proposed Codes May Change Your Cornea Diagnoses in October
Hereditary corneal dystrophies, corneal transplant complications might be coded differentl... Read more
Op Report Coding:
Translate These Common Acronyms to Decipher Op Reports
A few quick tips help you turn abbreviations into codes. Do you know your CRA from your I... Read more
Clip & Save:
Use This Guide to Define Eye-Focused Acronyms
We polled our experts and established a list of the most frequently documented abbreviatio... Read more
Patient Privacy:
Get A Handle on HIPAA Disclosure Laws
Can you bust these myths that involve the HIPAA Privacy Rule regulations? Most practices ... Read more
Reader Question:
Any Physician Can Use Emergency Department Codes
Question: An emergency department (ED) physician asked our ophthalmologist to see a patien... Read more
Reader Question:
Evaluate Need for Eyelid Modifiers
Question: A Medicare patient presented with severe dry-eye syndrome. The ophthalmologist p... Read more
Reader Question:
Can Medical Assistants Select Codes?
Question: One of our ophthalmologists allows his medical assistant to choose his E/M codes... Read more
You Be the Coder:
What's the Writeoff Policy With Secondary Payers?
Question: Thank you for your Q&A about patient writeoffs last month. I have a follow-u... Read more
Evaluation Codes:
Check the Answers to These 3 E/M FAQs
Hint: It doesn't pay to play it safe. It's easy to focus your coding and billing efforts ... Read more
Documentation:
Your Signature Can Be Worth Thousands
Hint: Don't forget attestations when signatures are late. You pride yourself on the metic... Read more
Billing:
Check This Primer on Timely Filing Rules
Hint: Track all claims to stay on track. Although most practices have become accustomed t... Read more
Reader Question:
Get the Scoop on 99211
Question: What are the rules regarding exactly when I can bill 99211 for a nurse visit? C... Read more
Reader Question:
Get the Scoop on Writeoffs
Question: We have had a few patients who don't pay their bills, even if we offer discounts... Read more
Reader Question:
Be Aware of the Unlisted Code Rules
Question: We reported 92499 for a service that had no CPT® code assigned to it but we are... Read more
You Be the Coder:
Look to 'G' Code for Glaucoma Screening
Question: We can't find a code in CPT® for glaucoma screenings for Medicare patients. How... Read more
Cataract Coding:
Can You Answer These Cataract Coding Questions?
Check this quiz to find out if you understand the cataract bundling rules. With complex c... Read more
E/M Coding:
4 Tips Help Curb Prolonged Service Coding Issues
Don't report another prolonged service until you read this. You're probably aware that th... Read more
Medicare Pay:
4 Tips for Smooth Consolidated Billing Practices
Seeing SNF patients can lead to payment hurdles if you don't know the rules. Almost every... Read more
Check This Sample Consolidated Billing Contract
Consolidated billing -- in which you bill the SNF directly for some services, and the SNF ... Read more
Reader Question:
CMS: New MBI Numbers Should Now Be the Norm
Question: How long do we have before we need to start reporting Medicare claims with ... Read more
Reader Question:
No One Answer to E/M Vs. Eye Code Question
Question: What criteria should eye care practices use when deciding between E/M codes and ... Read more
You Be the Coder:
Check This Modifier 59 Reminder
Question: Thanks for your article last month on the modifier 59 rules. The article said th... Read more
2019 Coding:
3 Tips Aid You in Reporting the 2019 CPT®, Diagnosis Codes
Hint: Evaluate laterality carefully when picking a diagnosis. Eye care practices have bee... Read more
Concurrent Care:
Account Carefully When Reporting Concurrent Care
Hint: Differentiate this service from duplicative care. Concurrent care scenarios are amo... Read more
CCI Edits:
CMS Clarifies Modifier 59 Usage Rules
Keep these tips in mind when deciding whether to separate edits. Some coders are so accus... Read more
Modifier 59 Isn't Automatically the Best Choice
Although CMS has clarified its regulations for when you can report modifier 59 (... Read more
Compliance:
Perform Self-Audits Efficiently With These 3 Tips
Dig into your records and get the pulse of your practice's health As Medicare auditors st... Read more
Reader Question:
Chief Complaint Must Venture Beyond Follow-up
Question: Our ophthalmologist lists the chief complaint for all follow-up visits using jus... Read more
You Be the Coder:
Bilateral Modifier Rules Can Get Confusing
Question:  Thank you for your article last month about bilateral coding. I have a fol... Read more
CMS Pay:
Optometrists Logged Nation's Highest DME Improper Payment Rate
Plus: Ophthalmologists suffered from upcoding errors. No one has ever said that coding fo... Read more
Get to Know CMS' Evaluation Criteria
CMS identified a total of $31.6 billion in total improper payments among providers during ... Read more
Unilateral/Bilateral Coding:
Do You Know Which Diagnostic Tests Are Inherently Bilateral?
The difference could change how you code your claims. Eye care coding often hinges on whe... Read more
Check These Examples of Unilateral, Bilateral Eye Services
Before you report the bilateral modifiers on your claim, make sure you know whether your e... Read more
ICD-10 Coding:
Do You Have Signs and Symptoms Questions? We've Got Answers
Find out what to code – and what to leave off your claims. Reporting ICD-10 codes isn't... Read more
Reader Question:
Vet Your Employees – Avoid This Ophthalmologist's Fate
Question: We are creating a new compliance policy, in which we'd like to include backgroun... Read more
Reader Question:
Get A Handle on New Vs. Established Patients
Question: We were recently audited and an established patient visit was marked as incorrec... Read more
You Be the Coder:
Are You Prepared to Bill Incident to?
Question: We recently hired a nurse practitioner at our ophthalmology office and have... Read more
Vision Care Coding:
MAC Rep: You Can Decide Whether to Report Refraction to Medicare
These and other questions were answered recently by one payer. Coding for eye care specia... Read more
2019 Payment:
Look Ahead to 2021 for Info on E/M Changes
Keep an eye on what may be coming up the pike. If your eye care staff members have been o... Read more
Looking Ahead:
Here's What to Expect in 2021
Although CMS won't be instituting big changes to E/M coding and documentation when the cal... Read more
Dry Eye Coding:
3 FAQs About Collecting for Schirmer's Testing
Hint: You won't find a code for the service in your manual. If you see patients with dry ... Read more
Reader Question:
Update Patient Records As New Cards Arrive
Question: We recently received a remittance advice and the number on it didn't match the n... Read more
Reader Question:
Go Beyond Diagnoses for YAG Laser Denial
Question: Our ophthalmologist used a YAG laser (66821) for a diagnosis of “vitreous stra... Read more
Reader Question:
Pinpoint SLT, ALT Codes
Question: If the physician performs SLT for glaucoma, which code should we report? What ab... Read more
You Be the Coder:
Watch Terminology With Consults
Question: Thank you for your article last month about consult coding. One of our main paye... Read more
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