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Ophthalmology and Optometry Coding Alert

CPT® 2025:
Get to Know the 2025 CPT® Revisions
Be prepared for a host of new telemedicine codes. It won't take a lot for you to stay abr... Read more
E/M Coding:
Let These 3 Tips Lead You to New vs. Established Patient Clarity
You can collect more for new patients — but check these guidelines first. What's the di... Read more
Practice Management:
Improve Provider, Coder, Biller Relations, Improve Outcomes and Revenue
Three different roles, the same shared goals. In her presentation “Documenting and Codi... Read more
You Be the Coder:
Does Proof of Prescription Prove an E/M Service?
Question: An established patient came in for a previously scheduled eye injection. Th... Read more
Reader Questions:
Leave Modifiers Off This POAG Exam Claim
Question: If a patient comes in with primary open-angle glaucoma (POAG), and we perfo... Read more
Reader Questions:
Beware This Humana Billing Snafu
Question: We just got a denial from Humana for billing 67028 together on the same cla... Read more
Reader Questions:
Understand NPI Types
Question: Are there different kinds of national provider identifiers (NPIs) for indiv... Read more
Compliance:
Take These Tips for Effective Ophthalmology Risk Management
And learn from these OIG settlements. The Department of Health and Human Services (HHS) O... Read more
Modifiers:
Get the Answers to Your Frequently Asked Modifier 24 Questions
Hint: not all postoperative services warrant using modifier 24. Have you used modifier 24... Read more
HIPAA:
Examine These 3 Cases, Stay Safe from HIPAA Violations
Avoid the fate of these healthcare entities with solid training and compliance strategies.... Read more
Reader Questions:
Get Specific With This Open-angle Glaucoma Dx
Question: If I code for chronic open-angle glaucoma, should I use H40.10X0 or H40.119... Read more
Reader Questions:
Get Money for Nothing in This Drug Sample Scenario
Question: One of our patients is having Eylea injections, but the provider is using a... Read more
Reader Questions:
Look Beyond Reimbursement When Reporting Z Codes
Question: Do the ICD-10-CM Z codes affect reimbursement, or are they strictly for st... Read more
You Be the Coder:
Get on the Right Side of this IOL PC TC Claim
Question: What is the correct way to bill 92136 when both the technical and professi... Read more
Gonioscopy:
Vanquish Misconceptions Hindering 92020 Claims
Get answers to your FAQs about postop, bilateral gonioscopy billing rules. There are sev... Read more
Fee-For-Time Billing:
Know These 7 Myths and 1 Truth About Fee-for-Time Billing
Prep now for summer FFT fill-ins, previously called locum tenens. Summer is in full swi... Read more
Best Practices:
Find Some Light in the Prior Authorization Maze
Hint: Don't forget to keep track of denials so you can troubleshoot your processes. Hea... Read more
Reader Questions:
Dig for These Details Before Billing Serial Tonometry
Question: Our ophthalmologist evaluated a patient with acute angle-closure glaucoma a... Read more
Reader Questions:
Solve This E/M Question
Question: Does an undiagnosed new problem with an uncertain diagnosis automatically m... Read more
Reader Questions:
Easily Fix EHR Errors
Question: How should we correct a mistake in an electronic health record (EHR)? Wash... Read more
You Be the Coder:
Recognize Which Details Impact Gonioscopy, VF Reporting
Question: A patient is in for a routine exam and has no complaints. The ophthalmologi... Read more
Foreign Body Removal:
Eye These Encounter Elements When Coding Ocular FBR
Look closely at the documentation for these clues to determine the right code. A common c... Read more
Medicare Tips:
Sharpen Your Medicare Signature Knowledge
Resolving your questionable signatures prior to claim submission is key. In your eye ca... Read more
HIPAA Help Desk:
Learn These 3 Truths and 3 Myths About PHI
Hint: De-identifying records may allow you to scrub PHI from them. From patient names to ... Read more
Reader Questions:
Find Out How To Handle Family History Facts
Question: When our ophthalmologists get referrals for procedures, the referring physi... Read more
Reader Questions:
Make Note of Medicare Overpayment Rules
Question: Who is responsible for identifying and correcting overpayment in any Medica... Read more
Reader Questions:
Explore Each of the 5 Medicare Denial Appeal Levels
Question: We filed a claim for a Medicare Part B patient with our Medicare Administr... Read more
You Be the Coder:
Pinpoint Proper Reporting for This FBR Encounter
Question: A welder presents with swelling in his left eye. The ophthalmologist finds ... Read more
Eye Injuries:
Can You Code These Ocular Trauma Cases?
Don't skimp on coding when you see a patient with an urgent diagnosis. While the primary ... Read more
Reimbursement:
Prevent Denials Before They Occur With These 4 Tips
Here's how to get all your documentation ducks in a row. If you've been experiencing an ... Read more
Practice Management:
Think Twice Before Waiving Co-Pays
See how a simple financial accommodation can cause a huge headache. Healthcare practiti... Read more
Reader Questions:
Base Injectable Drug Documentation on This Checklist
Question: When our physicians treat a patient via a drug injection, what should we b... Read more
Reader Questions:
Rely on Addendums for EHR Mistake Corrections
Question: How should we correct a mistake in an electronic health record (EHR)? Montana ... Read more
Reader Questions:
Medicare Ups Conversion Factor … Slightly
Question: Has there been any change to the Medicare Physician Fee Schedule (MPFS) con... Read more
You Be the Coder:
Verify Payer Preference Before Billing Punctal Plugs
Question: How do we bill for the placement of punctal plugs in all four eyelids in a ... Read more
Procedure Focus:
Sharpen Your Retina Injectable Rx Coding Skills
Follow these steps to ensure proper payment for drug injections. Although many of your t... Read more
Modifiers:
Be Wise in the Ways of Billing Wastage With -JW and -JZ
Also: Use this clinical example to help you calculate drug waste. Even the most experie... Read more
News You Can Use:
Review New Rules for Reporting Multiple Unlisted Procedures
Also, make note of the modifiers you can now use with unlisted codes. If your provider h... Read more
Reader Questions:
Phone-In This E/M Encounter
Question: A patient presented to the office for a follow-up appointment. When the pat... Read more
Reader Questions:
Learn the Importance of SDOH
Question: I know there's a huge push to document social determinants of health (SDOH... Read more
You Be the Coder:
Verify Vial Type To Ensure Correct Coding of Injectable Drugs
Question: Can you explain how to bill for triamcinolone acetonide when given as a bil... Read more
Condition Spotlight:
Learn Which Details Lend To Correct Coding of Hypotony Cases
Cause of condition may ease your code selection woes. Ophthalmologists are no strangers ... Read more
E/M Coding:
Gain Clarity Amidst MDM Coding Confusion
Hint: Getting the definitions down pat is half the battle. Although the medical decisio... Read more
Compliance:
Discover 4 Ways To Overcome Telehealth Compliance Obstacles
Contracted vendors are also obligated to adhere to HIPAA rules. Telehealth services have... Read more
Reader Questions:
Find Out How Isopters Factor Into VF Exam Code Choice
Question: We tend to use 92082 to avoid overcoding. When a patient undergoes visual f... Read more
Reader Questions:
See Who Did the Glaucoma Screening for Suitable Code Selection
Question: When a patient is screened for glaucoma, what codes should we report for t... Read more
Reader Questions:
Here’s How To Handle Notes With Vague Language
Question: Our providers are notorious for using “consistent with” and “likely... Read more
You Be the Coder:
Pinpoint Proper Reporting for These Ophthalmological Services
Question: A patient returns for follow-up. The provider notes improvement in the meib... Read more
Case Study Corner:
Get Answers to These Eye Injury Encounter Questions
See these NCCI code bundles clearly. If you're feeling hesitant about filing claims for p... Read more
Procedure Focus:
Keep Your MIGS Coding Know-How Current
Pay close attention to op note details to ensure your reporting is complete. Glaucoma is... Read more
E/M Coding:
Use These Pro Tips To Attain Telehealth Reporting Perfection
Bonus: Use this clip-and-save chart to answer future questions. There's no denying that ... Read more
Reader Questions:
Understand When You Can Bill for FS Laser Use
Question: Can you explain when it is, and is not, appropriate to charge for the use o... Read more
Reader Questions:
Make Sure All Who Work With PHI Get HIPAA Training
Question: Our practice occasionally uses temporary workers. Is it necessary to have n... Read more
Reader Questions:
Let Opacity Location Drive Secondary Cataract Sx Code Choice
Question: When a patient has a secondary membranous cataract following surgery and un... Read more
You Be the Coder:
Consider This Cat III Code for Xen Stent Insertion
Question: We've noticed an uptick in our surgeons' use of the Xen stent for aqueous ... Read more
Mythbuster:
Shatter These 4 Myths, Strengthen Signs and Symptoms Smarts
Get the 411 on what to code – and what to leave off – your claims. Choosing the ICD-1... Read more
Modifier Madness:
Minimize Laterality Modifier Snafus in 5 Simple Steps
Remember to review the fine print, as payer policies may differ. Even though every coder ... Read more
Compliance:
Brush Up on Medical Necessity Basics To Boost Claim Success
Also, get expert advice on establishing a risk assessment. There probably isn't an eye c... Read more
Reader Questions:
Don’t Be Caught Cloning Clinic Notes
Question: Our office has a medical scribe, and I have noticed that they sometimes ad... Read more
Reader Questions:
Check These Details Before Adding Modifiers to VF Claims
Question: We have a clinic with two offices in two different states, but only one of ... Read more
Reader Questions:
Choose the Correct Level for This Hospital Consult
Question: I'm trying to code a hospital consult and am struggling with the medical de... Read more
You Be the Coder:
Pick the Right Modifiers To Properly Report This Case
Question: A 27-year-old patient presented to the clinic stating that when he was mowing th... Read more
Medicare Physician Fee Schedule:
Turn Your Attention to These 2024 Final Rule Highlights
Steady reimbursement decline is a recipe for financial instability, AMA warns. Practices ... Read more
ICD-10 Coding Quiz:
Can You Code These Common Ocular Diagnoses Correctly?
See if you can spot the best-suited codes for these scenarios. Although coding for ophtha... Read more
Back to Basics:
Perfect Your Procedural Coding With These Pro Tips
Remember to exercise caution when using a modifier to break an NCCI edit. Chances are yo... Read more
Reader Question:
Examine Which Codes Are Modifier 50 Eligible
Question: How do I determine whether an eye care service can be reported bilaterally?... Read more
Reader Question:
Understand Proper Use of Modifiers X{EPSU}
Question: Can you explain when I should and shouldn't append the X{EPSU} modifiers? ... Read more
Reader Question:
Be Familiar With NCCI-Associated Modifiers
Question: What modifiers are allowed with the National Correct Coding Initiative (NCC... Read more
You Be the Coder:
Search for These Surgery Specifics When Coding IOL Exchange
Question: When our retina surgeon performs a lensectomy with insertion of an intraocu... Read more
Ophthalmology Coding:
Know When, and When not, to Bundle Goniotomy, Cataract Removal
Question: When our ophthalmic surgeon performs goniotomy in connection with the inser... Read more
Ophthalmology Coding:
Beware Coding for Blepharoptosis Repair
Question: Our ophthalmologist performed a technique to repair blepharoptosis by suspending... Read more
Ophthalmology Coding:
Ask These 6 Questions, Correctly Determine Diabetic Ophthalmic Complications
Test yourself with these two sticky situations. With almost 250 different diagnosis codes... Read more
Optometry/Ophthalmology Coding:
Know How to Report Progressive Lens Claims
Question: One of our patients has a plan that covers progressive bifocal lenses. I see the... Read more
Optometry/Ophthalmology Coding:
Figure out This Ocular FBR Case
Question: A patient presented to the emergency department (ED) with complaints of right ey... Read more
Optometry/Ophthalmology Coding:
Get Ready for MIPS and MVP Changes in the 2025 MPFS Final Rule
Plus — another rate cut is on the horizon. The Centers for Medicare & Medicaid Serv... Read more
Optometry/Ophthalmology Coding:
Get Familiar With Coding Goniotomy Procedures
Find out when you need to turn to Category III codes. Recently, there have been numerous ... Read more
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