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Ophthalmology and Optometry Coding Alert

Year in Review:
Get the Answers to Your 2023 Update Questions
Review this FAQ for a recap of the big changes from the last 12 months. Whether you're a ... Read more
E/M Coding:
Take Note of These Minor E/M Changes for 2024
Find out if the modified descriptors will change how the codes are used. The year is co... Read more
Compliance:
Focus on Cataract Surgery Billing Best Practices
Learn what three things are most apt to attract an auditor's attention. Because cataract... Read more
Reader Question:
Think Before Charging for Newer Technology Use in Cataract Sx
Question: Can you explain when it is and is not appropriate to charge for the use of ... Read more
Reader Question:
Brush Up on Telehealth Billing Basics
Question: If an established patient's visit starts as telehealth and they then come ... Read more
Reader Question:
Do This When Descriptors Say ‘Unilateral or Bilateral’
Question: Because payment for fluorescein angiography (FA) (92235), indocyanine-gree... Read more
You Be the Coder:
Know What’s Included in the Global Surgical Package
Question: I am trying to bill for the removal of sutures the ophthal­mologist placed... Read more
Procedure Focus:
Clear Up Cataract Sx Coding Confusion in 3 Simple Steps
Remember: You won't always bill for the lens, and some aren't fully covered. Nearly 20 p... Read more
Documentation:
Avoid Denials Due to Cataract Documentation Deficiencies
Learn the statements that'll help your charts stand up to audit scrutiny. Because catarac... Read more
MIPS Reporting:
See 7 Ways Your Small Practice Can Up Its MIPS Game
Take advantage of these tools to achieve success in the QPP. Submitting Merit-Based Incen... Read more
You Be The Coder:
Puzzle Out Which Codes To Submit for FB Sensation
Question: Our ophthalmologist saw a patient with a foreign-body (FB) sensation in her left... Read more
Reader Question:
Know Which Cataract Codes Support Surgery Necessity
Question: I'm not sure which diagnosis code to report when our ophthal­mologists dia... Read more
Reader Question:
Get That Vitreous Gel Drainage Means Vitrectomy
Question: When the ophthalmologist drains some of the vitreous gel in tandem with oth... Read more
Reader Question:
Don’t Unbundle Due To Treatment of Contiguous Structures
Question: When our surgeons perform mechanical vitrectomy and prophylactic photocoagu... Read more
ICD-10:
Take These Tips, Report Retinal Disorders Flawlessly
Learn the details that lead to maximum code specificity. Retinal conditions run the gamut... Read more
Mythbuster:
Rescue Your Claims From These Retina Repair Reporting Pitfalls
Remember: CPT® code 67108 isn't only for initial repairs. There are thousands of new de... Read more
HIPAA Help Desk:
Boost Your Practice’s Ability To Bypass HIPAA Blunders
Find out how to best fend off breaches and cybersecurity incidents. From privacy violat... Read more
Reader Questions:
Review the Right Way To Report This Retinal Detachment Eval
Question: An ophthalmologist in our practice saw a patient for flashes and floaters a... Read more
Reader Questions:
Draw On These Details To Decide New vs. Established E/M
Question: If a patient sees one ophthalmologist in our group practice, then one year... Read more
Reader Questions:
Let the Global Period Guide Your Post-Op Coding
Question: A Medicare patient undergoes panretinal laser photocoagulation (67228) in ... Read more
You Be the Coder:
Understand Proper Billing of Bilateral Laser Photocoagulation
Question: Do retina photocoagulation codes 67210 and 67228 represent bilateral proced... Read more
Medicare Physician Fee Schedule:
Pore Over 2024 MPFS Proposed Rule Pros and Cons
Blame ophthalmology and optometry payment cuts on budget neutrality. Expect some give and... Read more
News You Can Use:
Examine the Latest ICD-10 Z Code Expansion
And review the revamped SDoH guideline. As you know, Z codes capture information that sig... Read more
E/M:
Master Coding Patient Management Via Portal Messaging
Hint: Timing is everything. As technology advances, so does the practice of medicine. Pat... Read more
Reader Questions:
Factor Tests Ordered Into MDM Despite Patient Refusal
Question: During an office visit, the ophthalmologist orders optical coherence tomogr... Read more
Reader Questions:
Check This Detail To Correctly Code Colobomas
Question: What is a coloboma and what codes should I report for patients with this co... Read more
Reader Questions:
Report 92228 for Retinal Imaging With Remote I&R
Question: Primary care physicians (PCP) in our rural community sometimes ask our opht... Read more
You Be the Coder:
See the Modifier Selections for This Scenario
Question: A patient presented to the clinic complaining of foreign-body sensation and... Read more
News You Can Use:
Consider These Crucial 2024 ICD-10-CM Changes
Find expanded options for ocular conditions, SDoH, external causes, and more. With more ... Read more
CPT® Coding Quiz:
Assess Your Intraocular Lens Coding Aptitude
Put your IOL coding prowess to the test with these case scenarios. Ophthalmic surgeons im... Read more
Modifier Madness:
Let the Answers to These 5 FAQs Lead You to Modifier Perfection
Learn which modifier many MACs would rather you not use. Modifiers help paint a picture... Read more
Coding Quiz Answer:
Examine Our Expert Solutions to the IOL Coding Scenarios
Learn which situations warrant separate coding of an intraocular lens. Answer 1: C. CPT®... Read more
Reader Questions:
Appreciate When To Avoid Billing Additional Procedures
Question: When our ophthalmologist performs surgery reported with a code whose descriptor ... Read more
Reader Questions:
Can You Rectify This Bilateral Repair Billing Blunder?
Question: The ophthalmologist performed bilateral retinal tear repair (67145) on a Medicar... Read more
Reader Questions:
Check Payer Policy To Overcome Myopia Reporting Challenges
Question: Our ophthalmologist evaluated a patient complaining of blurry vision and diagnos... Read more
You Be the Coder:
Scour for Retinal Break Specifics Before Reporting H33 Series
Question: Our retinal doctor performed surgery for retinal detachment (67108) and said the... Read more
Diagnosis Focus:
Conquer Macular Degeneration Coding Concepts
Find the facts facilitating foolproof reporting of AMD cases. Nearly 20 million people in... Read more
CPT® Coding:
Don’t Lose Sight of These Specifics When Reporting AMD Interventions
Check CPT® code descriptors and globals to keep your coding in compliance. Age-related m... Read more
Modifier Madness:
Sharpen Your Modifier Skills With Answers to These FAQs, Part 1
Avoid misusing modifiers or risk inappropriate reimbursement, audits, and more. Althoug... Read more
Reader Questions:
Check This Detail When Choosing a Contact Lens Fitting Code
Question: My ophthalmologist routinely sees patients for services such as contact len... Read more
Reader Questions:
Cigna Pauses -25 Policy Implementation a Second Time
Question: Is Cigna now requiring the submission of documentation via email or fax to ... Read more
Reader Questions:
Examine This Expert Advice on Appending Modifier 51
Question: There has recently been a disagreement in our department regarding modifie... Read more
You Be the Coder:
Explore NCCI Edits Before Billing E/M With Vision Training
Question: Can we submit 99213 for an office visit and 92065 for vision training on th... Read more
Procedure Focus:
See 3 Ways To Boost Strabismus Claim Success
Keep reporting rules straight or risk losing rightful reimbursement. Strabismus surgery c... Read more
Reimbursement:
Boost Collections by Avoiding These 10 Billing Blunders
Here's how to save your practice money, time, and a whole lot of frustration. If denials ... Read more
ICD-10-CM Updates:
Find New Options for Reporting Issues Impacting Health Outcomes
And discover which codes are now unbillable parent codes. What happens outside a patient'... Read more
Reader Questions:
Look to ‘M’ Codes for Behçet’s Disease Dx
Question: What is Behçet's disease, and how is this condition coded? Florida Subscr... Read more
Reader Questions:
Decipher Between These 2 Similar SDoH Codes
Question: What is the difference between Z58.81 and Z59.12? We were looking over the ... Read more
Reader Questions:
Can You Code Strabismus Treatment via Botox Injection?
Question: How should I code for Botox injections to treat strabismus? Tennessee Subs... Read more
You Be the Coder:
Keep Strabismus Types Straight for Correct Coding
Question: Our ophthalmologist diagnosed a patient with monocular esotropia in the ri... Read more
Procedure Coding:
Decode Ophthalmoscopy Reporting Confusion
Find out which retinal imaging claims require saved images. Diabetic retinopathy is an ey... Read more
Case Study Corner:
Try Your Hand Coding This Diabetic Retinopathy Case
Correctly report everything from testing to treatment with these tips. Diabetic retinopa... Read more
News You Can Use:
Protect Payment by Perusing Cigna’s -25 Policy Updates
And bust three myths to up your Modifier 25 billing game. Get ready to jump through a few... Read more
Reader Questions:
Review What’s Required for Fundus Photography Reimbursement
Question: Is fundus photography covered by Medicare and other third-party payers, and what... Read more
Reader Questions:
Recognize How CPT® Categorizes AI-Related Procedures
Question: What are the different classifications of AI in CPT®, and which type does retin... Read more
Reader Questions:
Eye CMS’ QPP Resource Library To Keep Current
Question: I was recently put in charge of our practice's Quality Payment Program (QPP) pro... Read more
You Be the Coder:
Pinpoint Proper Coding of PRP for Proliferative Retinopathy
Question: Our ophthalmologist diagnosed a patient with bilateral proliferative diabetic re... Read more
Condition Spotlight:
Up Your Conjunctivitis Coding Game With These Tips
Learn which details help you choose between the B30.- and H10.- code groups. Ophthalmolo... Read more
CPT® Coding:
Navigate the Nuances of Ophthalmic Ultrasound Coding
Find out when permanently recorded images are a must. When scouring eye imaging notes, y... Read more
Practice Management:
Steer Clear of Post-PHE Snafus in 7 Simple Steps
Planning is paramount to ensure a seamless segue back to pre-PHE rules. Healthcare indus... Read more
Reader Questions:
Drill Down to Diagnoses That Support Dual Scans
Question: Which diagnoses support the performance of diagnostic ophthalmic ultrasoun... Read more
Reader Questions:
Recall Which Circumstances Call for Modifier 59
Question: When is it appropriate to break an NCCI edit with modifier 59?> Louisia... Read more
Reader Questions:
Look to the ICD-10-CM Guidelines for Sequencing Specifics
Question: A patient presents with a six-day history of a red, itchy, sticky right ey... Read more
You Be the Coder:
Can You Code This Ocular Echography Case Correctly?
Question: Our ophthalmologist submitted 76510-RT for the following case, but we recei... Read more
CPT® Coding:
Cultivate Spot-On Eyelid Procedure Coding With These 5 Tips
Look to the blepharoptosis repair codes when the fix involves muscle modification. Two of... Read more
ICD-10 Coding Quiz:
Check Your Corneal Coding Capabilities
See if you can zero in on the best-suited codes for each scenario. While coding for a sig... Read more
Audit Strategies:
Don’t Pay the Price for Not Having a Robust Audit Program
Make sure to clearly define audit scope to ensure everyone is on the same page. Don't fa... Read more
Reader Questions:
Don’t Release Results Without Patient Consent
Question: When an employer pays our office to perform vision tests, can we disclose t... Read more
Reader Questions:
Iron Out These Audit Details Before Reaching an Agreement
Question: We are getting an outside party to conduct an audit to evaluate our practic... Read more
Reader Questions:
Figure Out Which Cataract Code To Turn To
Question: Our practice just brought in a new physician and every time they perform c... Read more
You Be the Coder:
Differentiate Reconstructive vs. Cosmetic Blepharoplasty
Question: Our ophthalmologist performed blepharoplasty on a patient with a drooping ... Read more
Condition Spotlight:
Don’t Let Dry Eye Dollars Fall Through the Cracks
Understand DED coding nuances to safeguard your practice's reimbursement. Nearly half of ... Read more
E/M Coding:
Peruse 3 Pointers for Precise MDM Data Counting
Hint: Look beyond the codes to the guidelines for all the info you need. If you're one of... Read more
Documentation:
Follow This Advice to Fortify Your Medical Records
Remember: Timely medical record signoff helps to preserve chart accuracy. It's a good ide... Read more
Reader Questions:
Set the Stage for Superior Documentation
Question: Our practice is always looking for ways to bill better, but staying up with... Read more
Reader Questions:
Don’t Count on Separate Pay for Schirmer’s Testing
Question: Can I separately report Schirmer's tests and E/M services? Florida Subscr... Read more
Reader Questions:
Bill Patients Desiring Deluxe Frames the Difference
Question: What are the criteria to bill for deluxe frames with V2025 for a post-cata... Read more
You Be the Coder:
Size Up Your Eye Exam Coding Skills
Question: A 53-year-old new patient with type 1 diabetes presented to the clinic with... Read more
Medicare Physician Fee Schedule:
Focus on These 5 MPFS Final Rule Takeaways
Will payment cuts impede patient access to sight-saving procedures? Expect some give and ... Read more
Risk Adjustment:
Sharpen Your Risk Adjustment Coding Skills in 4 Easy Steps
Remember: Not all diagnoses risk-adjust. If you are looking for ways to boost your ophtha... Read more
Billing Basics:
Get the Scoop on Changes to Medicare Benefits for 2023
Let this Q&A shed light on how these updates will impact patients and reimbursement. ... Read more
Reader Question:
Establish This Rule for New Patient Encounters
Question: I have been reporting all services performed by our nurses, including those... Read more
Reader Question:
Understand Why You Shouldn’t Report 67255 With 66180
Question: Our coding team is unsure about whether we can report 66180 and 67255 together. ... Read more
Reader Question:
Eliminate Uncertainty When Deciding ‘Unspecified’ vs. ‘Other’
Question: Can you explain the difference between H16.8 and H16.9? I often have troubl... Read more
You Be the Coder:
Differentiate Between QHPs and Staff for Definitive Documentation
Question: There are times when a patient says something to ancillary staff, but there's no... Read more
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