Ophthalmology and Optometry Coding Alert
CPT® Coding:
Master Reporting of Glaucoma Surgical Interventions
Learn how to differentiate between goniopuncture and goniotomy. Primary open-angle glauc... Read more
Master Reporting of Glaucoma Surgical Interventions
Learn how to differentiate between goniopuncture and goniotomy. Primary open-angle glauc... Read more
Year-in-Review Quiz:
Is Your Coding Know-How Current? Take Our 2022 Year-in-Review Quiz
Answer these three questions to see if you're ready to hit the ground running in 2023. Do... Read more
Is Your Coding Know-How Current? Take Our 2022 Year-in-Review Quiz
Answer these three questions to see if you're ready to hit the ground running in 2023. Do... Read more
Billing Basics:
Let 5 FAQs Clarify Workers’ Comp
Using the right fee schedule may help you recoup an extra 15 percent. Submitting a worke... Read more
Let 5 FAQs Clarify Workers’ Comp
Using the right fee schedule may help you recoup an extra 15 percent. Submitting a worke... Read more
Coding Quiz Answers:
Check Your Answers to Our End-of-Year Coding Quiz
Find out if your coding knowledge is up to date. Once you've answered the quiz questions... Read more
Check Your Answers to Our End-of-Year Coding Quiz
Find out if your coding knowledge is up to date. Once you've answered the quiz questions... Read more
Reader Questions:
Understand When You Can and Cannot Also Code Goniotomy
Question: When our ophthalmic surgeon performs goniotomy in connection with the inser... Read more
Understand When You Can and Cannot Also Code Goniotomy
Question: When our ophthalmic surgeon performs goniotomy in connection with the inser... Read more
Reader Questions:
Zero In on Who’s Exempt From MIPS Participation
Question: What are some of the special statuses and exemptions that would allow our ... Read more
Zero In on Who’s Exempt From MIPS Participation
Question: What are some of the special statuses and exemptions that would allow our ... Read more
Reader Questions:
Feds Renew COVID-19 PHE Again
Question: What is the current status of the PHE for COVID-19, and when can we expect... Read more
Feds Renew COVID-19 PHE Again
Question: What is the current status of the PHE for COVID-19, and when can we expect... Read more
You Be the Coder:
Recognize That Canaloplasty Includes Goniotomy
Question: Our ophthalmologist performed both canaloplasty and goniotomy on a patient'... Read more
Recognize That Canaloplasty Includes Goniotomy
Question: Our ophthalmologist performed both canaloplasty and goniotomy on a patient'... Read more
E/M Updates:
Get Ready for Coding Outpatient Consultations in 2023
Know what to do when payers don't accept consultation codes. Last month, Ophthalmology an... Read more
Get Ready for Coding Outpatient Consultations in 2023
Know what to do when payers don't accept consultation codes. Last month, Ophthalmology an... Read more
ICD-10 Coding Quiz:
Test Your Ocular Dx Coding Skills With These Case Studies
Hint: Etiology may drive code choice when reporting cataracts. Although some diagnosis co... Read more
Test Your Ocular Dx Coding Skills With These Case Studies
Hint: Etiology may drive code choice when reporting cataracts. Although some diagnosis co... Read more
Modifier Madness:
Clear Up Concurrent Procedure Coding Confusion in 4 Easy Steps
Spot the billing error and remedy this CPT® coding conundrum. Sometimes your ophthalmolo... Read more
Clear Up Concurrent Procedure Coding Confusion in 4 Easy Steps
Spot the billing error and remedy this CPT® coding conundrum. Sometimes your ophthalmolo... Read more
Reader Question:
Know Only Certain Modifiers Can Bypass NCCI Edits
Question: Are there specific modifiers that I should use to unbundle a National Corre... Read more
Know Only Certain Modifiers Can Bypass NCCI Edits
Question: Are there specific modifiers that I should use to unbundle a National Corre... Read more
Reader Question:
Recognize Not All Payers Accept Consultation Codes
Question: Our ophthalmologist performed an inpatient consultation on a Medicare patie... Read more
Recognize Not All Payers Accept Consultation Codes
Question: Our ophthalmologist performed an inpatient consultation on a Medicare patie... Read more
Reader Question:
Don’t Expect OD Scope of Practice to Expand
Question: I heard from a colleague that optometrists (ODs) in California might soon b... Read more
Don’t Expect OD Scope of Practice to Expand
Question: I heard from a colleague that optometrists (ODs) in California might soon b... Read more
You Be the Coder:
Prepare to Alter How You Report Observation Services
Question: The ophthalmologist arrives at the hospital at 8 p.m. Wednesday to evaluate... Read more
Prepare to Alter How You Report Observation Services
Question: The ophthalmologist arrives at the hospital at 8 p.m. Wednesday to evaluate... Read more
E/M Updates:
Expect Streamlined Consultation Coding in 2023
Know where to turn for straightforward MDM once 99241 is scrapped. Be proactive and start... Read more
Expect Streamlined Consultation Coding in 2023
Know where to turn for straightforward MDM once 99241 is scrapped. Be proactive and start... Read more
ICD-10-CM 2023:
Explore New Ways to Report Transport Accidents, Drug Therapies, and More
And remember to assign Z91.A- codes to detail caregiver noncompliance. If your practice ... Read more
Explore New Ways to Report Transport Accidents, Drug Therapies, and More
And remember to assign Z91.A- codes to detail caregiver noncompliance. If your practice ... Read more
Mythbuster:
Save Your Claims From These 5 V Code Pitfalls
Know best practices for reporting transport accidents that cause injuries. ICD-10-CM 2023... Read more
Save Your Claims From These 5 V Code Pitfalls
Know best practices for reporting transport accidents that cause injuries. ICD-10-CM 2023... Read more
Reader Questions:
Keep Medical Record Reviews on Your Radar
Question: How concerned should we be about medical record reviews by the Centers for ... Read more
Keep Medical Record Reviews on Your Radar
Question: How concerned should we be about medical record reviews by the Centers for ... Read more
Reader Questions:
Preview Revised Aqueous Outflow Dilation Codes
Question: Our practice is trying to prepare now for all the upcoming coding changes. ... Read more
Preview Revised Aqueous Outflow Dilation Codes
Question: Our practice is trying to prepare now for all the upcoming coding changes. ... Read more
You Be the Coder:
Understand Conjunctival FB Coding Nuances
Question: Our ophthalmologist saw a patient in the morning who complained of a foreig... Read more
Understand Conjunctival FB Coding Nuances
Question: Our ophthalmologist saw a patient in the morning who complained of a foreig... Read more
News You Can Use:
Examine Pros and Cons of 2023 MPFS Proposed Rule
CMS is considering in-office cataract surgery, but CF will likely decrease. Physicians ma... Read more
Examine Pros and Cons of 2023 MPFS Proposed Rule
CMS is considering in-office cataract surgery, but CF will likely decrease. Physicians ma... Read more
ICD-10-CM 2023:
Find New Options for Dementia, Brain Injury Codes
Peruse these non-eye care code changes, as they will likely impact your reporting. Looki... Read more
Find New Options for Dementia, Brain Injury Codes
Peruse these non-eye care code changes, as they will likely impact your reporting. Looki... Read more
Social Determinants of Health:
Use New Z Codes to Paint a Complete Picture of Health
Review answers to the five most frequently asked questions about SDoH coding. Over the la... Read more
Use New Z Codes to Paint a Complete Picture of Health
Review answers to the five most frequently asked questions about SDoH coding. Over the la... Read more
Reader Question:
Consult MUEs Before Billing Bilateral Procedures
Question: I keep receiving denials for frequency when submitting two units of 65091 w... Read more
Consult MUEs Before Billing Bilateral Procedures
Question: I keep receiving denials for frequency when submitting two units of 65091 w... Read more
You Be the Coder:
Check for Slit Lamp Use Before Coding Corneal FB Removal
Question: Our ophthalmologist saw a patient complaining of pain and discomfort in hi... Read more
Check for Slit Lamp Use Before Coding Corneal FB Removal
Question: Our ophthalmologist saw a patient complaining of pain and discomfort in hi... Read more
Eye Visits:
Differentiate Eye Codes, E/M Codes With a Few Quick Tips
Both sets of codes apply to eye care specialists, so understand which to use and when. Op... Read more
Differentiate Eye Codes, E/M Codes With a Few Quick Tips
Both sets of codes apply to eye care specialists, so understand which to use and when. Op... Read more
E/M Coding:
You May Need to Do Some Sleuthing to Select Prolonged Service Codes
Hint: The difference between the two codes comes down to one word. When 2021 arrived, s... Read more
You May Need to Do Some Sleuthing to Select Prolonged Service Codes
Hint: The difference between the two codes comes down to one word. When 2021 arrived, s... Read more
HIPAA:
7 Quick Tips Can Keep You Up to Date on Privacy Policies
Update policies frequently, experts say. Although some eye care practices have put HIPAA... Read more
7 Quick Tips Can Keep You Up to Date on Privacy Policies
Update policies frequently, experts say. Although some eye care practices have put HIPAA... Read more
Reader Questions:
Can You Identify a Vision Plan?
Question: We had a patient present her insurance card and when she left, the office m... Read more
Can You Identify a Vision Plan?
Question: We had a patient present her insurance card and when she left, the office m... Read more
Reader Questions:
Do You Know the Glaucoma Screening Codes?
Question: How do we report glaucoma screening, and who can perform it? Florida Subsc... Read more
Do You Know the Glaucoma Screening Codes?
Question: How do we report glaucoma screening, and who can perform it? Florida Subsc... Read more
Reader Questions:
Determine When Modifier 58 Is Warranted
Question: We had a patient return during the 90-day postoperative period of a focal l... Read more
Determine When Modifier 58 Is Warranted
Question: We had a patient return during the 90-day postoperative period of a focal l... Read more
You Be the Coder:
Understand When 92310 Is Warranted
Question: We know we can't bill Medicare for regular refractive contact lenses, but h... Read more
Understand When 92310 Is Warranted
Question: We know we can't bill Medicare for regular refractive contact lenses, but h... Read more
Low Vision Rehabilitation:
Can You Accurately Code Both Parts of the Vision Rehab Process?
Hint: The initial visit may simply involve an E/M code. When most medical specialty coder... Read more
Can You Accurately Code Both Parts of the Vision Rehab Process?
Hint: The initial visit may simply involve an E/M code. When most medical specialty coder... Read more
Surgical Coding:
4 Tips Help You Understand the Global Surgical Package Rules
Remember that modifier 54 must always accompany modifier 55. Although a surgical procedur... Read more
4 Tips Help You Understand the Global Surgical Package Rules
Remember that modifier 54 must always accompany modifier 55. Although a surgical procedur... Read more
Mythbuster:
3 Coding Habits to Eliminate From Your Life
Improving your first-pass acceptance ratio might be easier than you think. The phrase, â€... Read more
3 Coding Habits to Eliminate From Your Life
Improving your first-pass acceptance ratio might be easier than you think. The phrase, â€... Read more
Reader Questions:
Use 2 Lines for Progressive Lens Claim
Question: Our patient has a plan that pays for progressive bifocals. How should we r... Read more
Use 2 Lines for Progressive Lens Claim
Question: Our patient has a plan that pays for progressive bifocals. How should we r... Read more
Reader Questions:
Roll Suture Removal Into E/M Service
Question: Can we code for suture removal when our ophthalmologist isn't the physician... Read more
Roll Suture Removal Into E/M Service
Question: Can we code for suture removal when our ophthalmologist isn't the physician... Read more
You Be the Coder:
2 Visits May Not Mean 2 E/M Codes
Question: One of our ophthalmologists saw a patient in the morning for a cataract eva... Read more
2 Visits May Not Mean 2 E/M Codes
Question: One of our ophthalmologists saw a patient in the morning for a cataract eva... Read more
Benchmarking:
Evaluate Your Practice’s Coding Trends With a Benchmarking Analysis
One recent case shows why utilization trends are important. If you've heard that insuranc... Read more
Evaluate Your Practice’s Coding Trends With a Benchmarking Analysis
One recent case shows why utilization trends are important. If you've heard that insuranc... Read more
Clip and Save:
Check This Breakdown of Which Codes Ophthalmologists, Optometrists Are Reporting Nationwide
Once you compare your practice's benchmarking data over time, you may want to take the nex... Read more
Check This Breakdown of Which Codes Ophthalmologists, Optometrists Are Reporting Nationwide
Once you compare your practice's benchmarking data over time, you may want to take the nex... Read more
Diagnostic Testing:
Check 3 FAQs to Understand Extended Ophthalmoscopy
Hint: Don't report these codes bilaterally. Extended ophthalmoscopy (EO) is one of the mo... Read more
Check 3 FAQs to Understand Extended Ophthalmoscopy
Hint: Don't report these codes bilaterally. Extended ophthalmoscopy (EO) is one of the mo... Read more
Substitute Physicians:
Summer Is Approaching: Understand How to Report Locum Tenens Services
Don't let the NPI nuances slip your mind when billing for substitute physicians. With w... Read more
Summer Is Approaching: Understand How to Report Locum Tenens Services
Don't let the NPI nuances slip your mind when billing for substitute physicians. With w... Read more
Reader Questions:
Patient’s Condition Doesn’t Dictate E/M Code Level
Question: A patient returned for a six-month follow-up after undergoing a biopsy of h... Read more
Patient’s Condition Doesn’t Dictate E/M Code Level
Question: A patient returned for a six-month follow-up after undergoing a biopsy of h... Read more
Reader Questions:
Understand ICD-10-CM Rules When No Diagnosis Is Found
Question: Which diagnosis codes would we use for a visual field (VF) test to rule ou... Read more
Understand ICD-10-CM Rules When No Diagnosis Is Found
Question: Which diagnosis codes would we use for a visual field (VF) test to rule ou... Read more
You Be the Coder:
Can IOL Calculations Be Reported Bilaterally?
Question: If the physician calculates intraocular lens (IOL) power in both eyes, sho... Read more
Can IOL Calculations Be Reported Bilaterally?
Question: If the physician calculates intraocular lens (IOL) power in both eyes, sho... Read more
Inpatient Coding:
Remember History, Exam, and MDM Elements for Hospital E/M Visits
It's time to go retro when you're reporting these services. Whether your ophthalmologist ... Read more
Remember History, Exam, and MDM Elements for Hospital E/M Visits
It's time to go retro when you're reporting these services. Whether your ophthalmologist ... Read more
Refraction:
5 Steps Help Create a Stress-Free Refraction Billing System
Use these tips to smooth the conversation with your patients. Performing refraction servi... Read more
5 Steps Help Create a Stress-Free Refraction Billing System
Use these tips to smooth the conversation with your patients. Performing refraction servi... Read more
Nurse Visit Coding:
Master 99211 and Code Nurse Visits Properly Every Time
Hint: The time element was removed from the 99211 descriptor last year. Whether you repor... Read more
Master 99211 and Code Nurse Visits Properly Every Time
Hint: The time element was removed from the 99211 descriptor last year. Whether you repor... Read more
Reader Questions:
Understand How to Deal With Patient Refusal to Pay
Question: A patient presented for his eye appointment and got belligerent when we showed ... Read more
Understand How to Deal With Patient Refusal to Pay
Question: A patient presented for his eye appointment and got belligerent when we showed ... Read more
You Be the Coder:
Can You Report 92002 and 99204 Together?
Question: We're confused about what codes we would report for an office visit. Can we bill... Read more
Can You Report 92002 and 99204 Together?
Question: We're confused about what codes we would report for an office visit. Can we bill... Read more
Retinopathy Coding:
Quiz: Can You Code Laser Treatments Related to Diabetic Retinopathy?
Keeping track of all the variables involved can be challenging. According to the Centers ... Read more
Quiz: Can You Code Laser Treatments Related to Diabetic Retinopathy?
Keeping track of all the variables involved can be challenging. According to the Centers ... Read more
Compliance:
Pandemic Brings Optometrist’s Fraudulent Practices to Light
Avoid his fate by catching coding and billing inaccuracies as soon as you see them. Many... Read more
Pandemic Brings Optometrist’s Fraudulent Practices to Light
Avoid his fate by catching coding and billing inaccuracies as soon as you see them. Many... Read more
Part B Coding:
From Modifiers to Appeals, Check This 2022 Coding Advice, Straight From Part B Reps
Remember those appeal timelines. From reporting split/shared services to moving forward w... Read more
From Modifiers to Appeals, Check This 2022 Coding Advice, Straight From Part B Reps
Remember those appeal timelines. From reporting split/shared services to moving forward w... Read more
Reader Questions:
Low-Risk Glaucoma Screenings May Warrant ABN
Question: Our office sometimes performs glaucoma screenings for patients who don't me... Read more
Low-Risk Glaucoma Screenings May Warrant ABN
Question: Our office sometimes performs glaucoma screenings for patients who don't me... Read more
You Be the Coder:
Can You Pick the Right Botox Code?
Question: How would I report a Botox injection to control blepharospasm in only one e... Read more
Can You Pick the Right Botox Code?
Question: How would I report a Botox injection to control blepharospasm in only one e... Read more
Surgery:
6 Tips Lead to Error-Free Cataract Coding
Don't assume that medical necessity is implied. Cataracts are a prevalent issue, affectin... Read more
6 Tips Lead to Error-Free Cataract Coding
Don't assume that medical necessity is implied. Cataracts are a prevalent issue, affectin... Read more
Inpatient Coding:
Bust These Common Myths to Code Inpatient Visits Properly
Remember: Hospital E/M coding rules didn't change last year. All the changes to the offic... Read more
Bust These Common Myths to Code Inpatient Visits Properly
Remember: Hospital E/M coding rules didn't change last year. All the changes to the offic... Read more
Modifiers:
Capture Separate E/M Pay With 3 Tips
Understand what counts as ‘separately identifiable.' Reporting a separate evaluation a... Read more
Capture Separate E/M Pay With 3 Tips
Understand what counts as ‘separately identifiable.' Reporting a separate evaluation a... Read more
Use This Handy Tool to Differentiate Between Modifiers 25 and 57
Your modifier 25 claims should meet all of the following criteria: The E/M occurs on th... Read more
Your modifier 25 claims should meet all of the following criteria: The E/M occurs on th... Read more
Reader Questions:
Understand How to Differentiate 99050 From 99051
Question: When it comes to billing after-hours or evening codes, is it true that ther... Read more
Understand How to Differentiate 99050 From 99051
Question: When it comes to billing after-hours or evening codes, is it true that ther... Read more
Reader Questions:
Decode This Blepharoptosis Scenario
Question: The ophthalmologist performed a technique to repair blepharoptosis by susp... Read more
Decode This Blepharoptosis Scenario
Question: The ophthalmologist performed a technique to repair blepharoptosis by susp... Read more
You Be the Coder:
Can You Correctly Apply +67331?
Question: When should I use +67331? I have been told in the past to only use the code if t... Read more
Can You Correctly Apply +67331?
Question: When should I use +67331? I have been told in the past to only use the code if t... Read more
Compliance:
Eye Care Specialists Responsible for Over $177 Million in Projected Improper Payments
Plus: Optometrists logged a nearly 90 percent DME error rate. Eye care coders have to rem... Read more
Eye Care Specialists Responsible for Over $177 Million in Projected Improper Payments
Plus: Optometrists logged a nearly 90 percent DME error rate. Eye care coders have to rem... Read more
Discover Which States Logged the Highest Error Rates
CMS and the Medicare Administrative Contractors (MACs) process claims from all 50 U.S. sta... Read more
CMS and the Medicare Administrative Contractors (MACs) process claims from all 50 U.S. sta... Read more
ICD-10:
Coding Ophthalmic Manifestations of Diabetes? Don’t Limit Yourself to E11.9
Follow a few crucial tips to find the right diagnosis code. When diabetes leads to visi... Read more
Coding Ophthalmic Manifestations of Diabetes? Don’t Limit Yourself to E11.9
Follow a few crucial tips to find the right diagnosis code. When diabetes leads to visi... Read more
Coding Edits:
Confused About MUEs? Consider These 4 Facts
Medically unlikely edits appear to be here to stay, experts say. If your eye care practic... Read more
Confused About MUEs? Consider These 4 Facts
Medically unlikely edits appear to be here to stay, experts say. If your eye care practic... Read more
Reader Questions:
Get to Know FBR Bundling Rules
Question: Are all foreign body removals (FBRs) within the same eye bundled? Arizona Subsc... Read more
Get to Know FBR Bundling Rules
Question: Are all foreign body removals (FBRs) within the same eye bundled? Arizona Subsc... Read more
Reader Questions:
Is This a HIPAA Breach?
Question: An employee at our ophthalmology practice accessed records for no legitimate rea... Read more
Is This a HIPAA Breach?
Question: An employee at our ophthalmology practice accessed records for no legitimate rea... Read more
Reader Questions:
Amendments Require Careful Attention
Question: One of our physicians made mistakes on several charts and printed out new d... Read more
Amendments Require Careful Attention
Question: One of our physicians made mistakes on several charts and printed out new d... Read more
You Be the Coder:
Understand Reporting Astigmatic Contacts
Question: Which code should we use for monthly replacement toric contacts? We have been us... Read more
Understand Reporting Astigmatic Contacts
Question: Which code should we use for monthly replacement toric contacts? We have been us... Read more
ICD-10-CM Coding:
Vague Complaints Don’t Have to Lead to Vague Coding Solutions
Save your practice from denials by accurately coding nonspecific complaints. When a patie... Read more
Vague Complaints Don’t Have to Lead to Vague Coding Solutions
Save your practice from denials by accurately coding nonspecific complaints. When a patie... Read more
Part B Payments:
Ophthalmology, Optometry Pay to Remain Flat in 2022
Plus: Medicare's 2022 Final Rule also provides insight into split/shared visits. Eye care... Read more
Ophthalmology, Optometry Pay to Remain Flat in 2022
Plus: Medicare's 2022 Final Rule also provides insight into split/shared visits. Eye care... Read more
Incident-To Coding:
10 Tips Help You Straighten out the Incident-To Coding Rules
You may think you understand all of the nuances about how to code incident-to services, bu... Read more
10 Tips Help You Straighten out the Incident-To Coding Rules
You may think you understand all of the nuances about how to code incident-to services, bu... Read more
Reader Questions:
Understand Face-to-Face Visit Rules
Question: I read that when reporting discharge day management service, we must provi... Read more
Understand Face-to-Face Visit Rules
Question: I read that when reporting discharge day management service, we must provi... Read more
Reader Questions:
Maintain Lab and Diagnostic Test Orders
Question: Our insurer wants to audit our test orders — what does this mean? Georg... Read more
Maintain Lab and Diagnostic Test Orders
Question: Our insurer wants to audit our test orders — what does this mean? Georg... Read more
You Be the Coder:
Can You Find This Modifier Mishap?
Question: Medicare regulations indicate that separate ICD-10 codes are not required to rep... Read more
Can You Find This Modifier Mishap?
Question: Medicare regulations indicate that separate ICD-10 codes are not required to rep... Read more