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Optometry Coding & Billing Alert

CPT 2006 Update:
Reporting 92390-92396 for 'Supply of Materials'? Not Anymore
Plus: You'll be using office visit E/M codes more often beginning Jan. 1, experts say... Read more
Quick Quiz:
Understand the Requirements For Accurate Tech Billing
COT and COA services can boost the E/M level--if they abide by incident-to rulesCertified ... Read more
You Be the Expert:
Know the OCT Options
Question: Our office is considering purchasing an OCT instrument. What does the machine do... Read more
News You Can Use:
Is Your E/M Coding Measuring Up? Check CMS' Checklist
After 3 years, faces familiar to your optometry practice are new againIf a patient you las... Read more
2006 RVU Update:
Brace Your Bottom Line for Lower Post-Op Cataract Care Reimbursement
Medicare's 4.4 percent fee reduction also means $5 less for each B-scan and comprehensive ... Read more
HIPAA Corner:
Use 5 Guidelines to Prevent Internet Attacks
Send e-mail scams to the recycling bin with these tipsThink your employees know how to sto... Read more
READER QUESTIONS:
Yield to Carrier Discretion for Visual Fields
Question: Our doctor saw a patient for droopy eyelids, and to determine the extent to whic... Read more
READER QUESTIONS:
Fear Not When Medicare Comes for You
Question: Our Medicare carrier is doing a lot of prospective audits. How can we respond in... Read more
READER QUESTIONS:
Collect the Lower of 2 Copays
Question: I-m not always sure what to do when a patient comes in with a primary and second... Read more
READER QUESTIONS:
Help Patients Understand ABN Contents
Question: We have a patient who signed an advance beneficiary notice, and as we suspected,... Read more
Put a Lid on Eyelid Modifier Confusion
Do you need E1-E4 for punctal plugs and epilation?Thanks to the abundance of bilateral cod... Read more
HIPAA Question of the Month:
Share Info for Treatment Only
Question: One of our office employees moonlights at a long-term care facility. Under what ... Read more
Chart a Course for Ultimate Audit Success in 4 Easy Steps
Tip:  Experience trumps titles when choosing an internal auditorEven small optometry ... Read more
Are You Raising a Red Flag? Check Your Billing Frequency Against National Statistics
If your E/M code distribution looks much different from Medicare's data, you may attract a... Read more
You Be th Expert:
Spread Out FP and OCT Tests
Question: My Medicaid carrier just requested repayment for all claims for fundus photograp... Read more
Avoid Double Trouble by Squelching Duplicate Billing
Repeatedly billing until you're paid may work for private payers, but CMS could brand you ... Read more
Correction
An article in the November 2005 Optometry Coding & Billing Alert, -Are You Raising a R... Read more
READER QUESTIONS:
Bill Part B for Certain SNF Services
Question: Can an optometrist bill Medicare for services performed at an assisted-living fa... Read more
READER QUESTIONS:
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 QUESTIONS:
Discourage DMERC Denials With Proper POS
Question: I have gotten a denial from our DMERC for a patient's bifocal lenses post catara... Read more
Crack Cataract Co-Management Coding With These 3 Modifiers
"Tip:  Your follow-up service begins the day after the ophthalmic surgeon relinquishe... Read more
ICD-9 2006 Reminder:
Start Using New Nonproliferative DR Diagnosis Codes Soon
Distinguish among mild, moderate or severe retinopathy beginning Oct. 1The new year starts... Read more
Back to CPT Basics:
Have You Made Your Case for 99214? Read This, Then Decide
Determine whether you're basing your coding on time spent with the patientOffice visit cod... Read more
Clip and Save:
Use This Worksheet to Simplify Cataract Co-Management
Keep all of your critical postoperative care data at your fingertipsWhen it's time to subm... Read more
You Be the Expert:
Performing Tech Component of Topography
Question: A patient was referred to us for just corneal topography. We performed the test ... Read more
HIPAA Question of the Month:
Understand Authorizations and NPP
Question: I often have a hard time explaining to patients why they must sign a PHI authori... Read more
READER QUESTIONS:
Get Serious With Serial Tonometry Code
Question: I have a patient I-m following for glaucoma. I-ve asked him to come back four ti... Read more
READER QUESTIONS:
Append 25 to Visit Code, Not Test
Question: Should I append modifier 25 to 92225 when I-m also reporting a comprehensive eye... Read more
READER QUESTIONS:
Waive Fees for Colleagues and Put Doctors at Risk
Question: One of the doctors in my practice has asked me to waive the charges for services... Read more
2006 RVU Update:
Brace Yourself-Proposed Schedule Slashes Fees for Most Eye Procedures
Prepare to lose up to $11 on B-scans-thanks to a 4.3 percent conversion factor reductionIf... Read more
Expand Your Billing Options For Patients Refusing Dilation
Tip: You can schedule a second office visit - but beware this coding stipulationYou know t... Read more
You Be the Expert:
A-Scan With Exam on Second Eye
Question: After we had done an A-scan on a patient prior to cataract surgery on his left e... Read more
News You Can Use:
Add 4th Criterion for Glaucoma Screening Candidates in 2006
CMS may add Hispanics 65 and older to the list of those eligible for G0117Last month, we g... Read more
Clarification:
Good News-Expect $73 for Extended Visual Fields
An article in the July 2005 Optometry Coding & Billing Alert, "Conquer the Pre-Blephar... Read more
READER QUESTIONS:
Fight Underpayment for Keratoconus Lenses
Question: We are fitting quite a few of our keratoconus patients with a new type of contac... Read more
READER QUESTIONS:
Smile for Photos to Track Disease Progress
Question: I'm not sure when I can and can't bill for slit-lamp photography. What are the r... Read more
READER QUESTIONS:
Seek Payment From Dead Patient's Estate
Question: I'm trying to collect on an account and have just learned that the patient has r... Read more
READER QUESTIONS:
Use V Code to Check for Steroid Effects
Question: We're starting to see patients for visual field testing to check for adverse eff... Read more
READER QUESTIONS:
Handle Insurer Overpayments Quickly
Question: How should I handle overpayments by insurers? How fast do I have to repay? If th... Read more
READER QUESTIONS:
Modify Less Extensive Code With 59
Question: I know that I can use modifier 59 to unbundle codes under the right circumstance... Read more
Reduce Your Risk of Improperly Coding Glaucoma Screenings
Asking the right questions before billing G0117 can save you $45 per procedure and keep yo... Read more
News You Can Use:
Bill Medicare for Vision Rehab In Selected Cities
CMS tests the waters for full low-vision rehabilitation reimbursementOptometrists who supe... Read more
You Be the Expert:
Check EO Frequency
Question: What are the rules regarding how often I can report extended ophthalmoscopy on o... Read more
Consider 3 Key Factors Before Saying 'Yes' to Another Carrier
Don't take on an additional payer if the hassle will outweigh the paymentsWhen you don't u... Read more
Clarification:
Append LT and RT to Post-Op Code
A Reader Question in the July 2005 Optometry Coding & Billing Alert, "Use 54 to... Read more
READER QUESTIONS:
Report Refraction for Medicare Patient
Question: A Medicare patient came in just to have his prescription updated. If I only perf... Read more
READER QUESTIONS:
Don't Let Age Drive Diabetes Diagnosis
Question: We recently had a 16-year-old patient with underlying diabetes. We weren't sure ... Read more
READER QUESTIONS:
Protect PHI-Purge Plain-Text E-mails
Question: We do not now have any encryption services on our office e-mail system. How can ... Read more
READER QUESTIONS:
Manage Timely Filling Limits
Question: We keep getting unnecessary denials because we keep missing timely filing deadli... Read more
READER QUESTIONS:
Check In Patients-Not Privacy Violations
Question: We would like patients to write down their date of birth or the last four digits... Read more
READER QUESTIONS:
Assess Patient Cooperation
Question: We like to arrange mutually agreeable payment plans with patients whenever possi... Read more
Conquer the Pre-Blepharoplasty Visual Field Coding Conundrum
"Stop throwing away $20 every time you do two VFs for a carrier that only pays for one To... Read more
NCCI 11.2 Update:
Relax: No News Is Good News For Optometrists
Heads-up if you are reporting these G codes The latest batch of coding edits takes effect... Read more
Rely on These VF Diagnosis Codes
Prove the procedure isn't cosmetic with 368.40 and more Medicare is very picky about payi... Read more
Split the Bill for Full Payment For OD's SNF Visits
Part B may not cover the full service - are you responsible for the rest? Optometrists of... Read more
Steer Clear of SNF Billing Snafus by Taking 4 Steps
Our contract will help ODs sniff out full payment from nursing facilitiesDealing with co... Read more
Use This Sample Contract for SNF Visits
Take two copies of this contract on every SNF visit - one to keep for billing records and ... Read more
You Be the Expert:
Does Complaint Justify Eye Exam?
Question: I had a patient with eye pain and I found a lash that was irritating the cornea.... Read more
Clarification:
Append LT and RT to Post-Op Code
A Reader Question in the July 2005 Optometry Coding & Billing Alert, "Use 54 to Unlock... Read more
Reader Questions:
Use 54 to Unlock Post-Op Pay
Question: We're having trouble filing for postoperative care for a YAG. How should we code... Read more
Reader Questions:
Include Cost of Report With Consult Code
Question: Can an optometrist bill for a written report to the physician who originally ref... Read more
Reader Questions:
Pack Both Eyes Into Pachymetry
Question: I am not clear on how to bill pachymetry correctly. Previously, I was able to bi... Read more
Reader Questions:
Don't Try Documentation Time Travel
Question: This past July we billed 99213 for an office visit. Now, the patient's insurance... Read more
Reader Questions:
Avoid Authorization Frustration
Question: Our employees often have a hard time explaining to patients why they must sign a... Read more
ICD-9 2006 Update:
Describe Specifics With New NPDR Dx Codes
Get used to these codes fast - you'll need to start using them in October Optometry coder... Read more
Focus on Bilateral Status for Solid OCB and A-Scan Billing
Skipping these -26 and -TC rules could be costing you $86 per patient Calculating IOL str... Read more
Code Only 1 Procedure for Each IOL Patient
Reporting 76519 and 92136 together? Not so fast - take a look at the NCCI rulesEven when c... Read more
HIPAA Corner:
Communicate With Staff to Eliminate PHI Mishaps
Use this professional guidance to protect your patients' health information An optometry ... Read more
You Be the Expert:
Vision Insurance and Medical Diagnoses
Question: If a patient with both medical and vision insurance comes in for a routine exam ... Read more
Protect PHI With De-Identification
Check out our checklist for a guide to what HIPAA considers identifying information Optom... Read more
Reader Questions:
Code Gonioscopy Separately From Eye Exam
Question: Can we bill Medicare for both an intermediate established patient exam and a gon... Read more
Reader Questions:
Prove Necessity for Large Bifocal Segs
Question: I'm really confused about codes V2219 and V2319 for Medicare patients. I know it... Read more
Reader Questions:
Don't Tax Carriers' Patience
Question: Is there a specific code to use for sales tax when it is listed as a separate li... Read more
Reader Questions:
Rely on 99341-99350 for OD House Calls
Question: I am going to see a terminally ill patient at home tomorrow. She's a new patient... Read more
Reader Questions:
Verify Insurance Coverage Prior to Visit
Question: An oversight at the front desk occasionally results in our office seeing a patie... Read more
Reader Questions:
Don't Try Documentation Time Travel
Question: This past July we billed 99213 for an office visit. Now, the patient's insurance... Read more
Myth Buster:
Reporting Extended Ophthalmoscopy Bilaterally? Read This First
Learn the truth behind these common EO misconceptions and earn $23 per procedureIt's a com... Read more
Streamline Appeals Processes, Or Lose Sight of Thousands
In 9 months, you'll have less time for CMS appeals - is your practice ready?Good optometry... Read more
Quick Quiz:
Pluck Out the Right Codes for Epilation Billing
Lash out at these 4 questions to test your trichiasis talentsEpilation to correct trichias... Read more
News You Can Use:
Aetna Approves SLGT for Glaucoma Patients
The carrier now considers 92135 medically necessary in some - but not all - casesIf you're... Read more
Focus on OIG Directives for Crystal-Clear Compliance
Small practices need compliance plans as much as the big ones doEvery optometry practice n... Read more
You Be the Expert:
Irrigation and Duct Probe
Question: Can an optometrist bill for irrigation and duct probe? If so, how would I code f... Read more
READER QUESTIONS:
Insert -25 for E/M With Plug Procedures
Question: Can I report an office visit when I insert punctal plugs? How should I do that?O... Read more
READER QUESTIONS:
Watch Medicaid Limits for Secondary Payments
Question: I have a patient who has Medicare primary and Medicaid secondary. When I submit ... Read more
READER QUESTIONS:
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 QUESTIONS:
Choose Consult Code for Doctor-Requested Visits
Question: A local gastrointestinal doctor asked me to check one of his patients for the pr... Read more
Spotlight Modifiers for SLGT to Stop Getting Zapped by Payers
Getting reimbursed for 92135 can be tricky, but our expert coding tips will leave your cla... Read more
Prove Medical Necessity for SLGT With These ICD-9 Codes
Carriers are finicky about 92135 - check this list for approved diagnoses Scanning laser ... Read more
Clip and Save:
Get Hip to HIPAA Before It's Too Late
Prepare your optometry practice for this month's security rule deadlineIs your optometry o... Read more
Don't Blur Privacy Issues for Your Patients
Create a confusion-free NPP to avoid compliance crackdowns Even if your optometry practi... Read more
You Be the Expert:
Schirmer's Tear Test
Question: I'm having trouble finding a CPT code for a Schirmer's tear test. How can I bill... Read more
Post-Op Management Corner:
Implement These 5 Tips Today for Ironclad Cataract Care Billing
Modifiers and codes are crucial - but so is being friendly with the surgeon's billing staf... Read more
Reader Questions:
Check Policy for Pachymetry
Question: What code should I use for pachymetry?Massachusetts Subscriber Answer: Report C... Read more
Reader Questions:
Use 2 Lines for Bifocal Billing
Question: How would I go about billing a progressive bifocal to those plans that pay for m... Read more
Reader Questions:
Delay Gratification for Dilated Exam
Question: How should we handle it when a patient who has come in for a regular eye exam in... Read more
Reader Questions:
Pay the Right Doc by Tracking Incident-To Services
Question: I am a biller for a group practice with 12 physicians and four nonphysician prac... Read more
Reader Questions:
Give Health Info Over Phone as Last Resort
Question: We sometimes get calls from patients wanting their medical information over the ... Read more
Don't Let Global Periods Plug Up Your Plug-Insertion Cash Flow
Rely on documentation and modifier -58 for permanent implant payment When you insert perm... Read more
HIPAA Corner:
Think a PHI Authorization Is Forever? Think Again
Don't share your patient's new vision information without a new authorization One year ag... Read more
Keep Your Plug Coding Options Straight With This Easy Guide
One eye or both? Which eyelid? The answers affect how you bill Two eyes, four eyelids - ... Read more
You Be the Expert:
Consults for Doctors in Same Practice
Question: We have a joint practice with an optometrist and an ophthalmologist. Can the OD ... Read more
Billing Separately for Each Foreign Body? Not So Fast
FB removal coding depends on the site - and on the whims of the carrier "A consultant adv... Read more
Clarification:
Modifiers in an HPSA
An article in the February 2005 Optometry Coding & Billing Alert, "Think You've Mast... Read more
Reader Questions:
Keep Patients Happy by Filing Secondary Claims
Question: A patient's primary insurer is Medicare, and she also has a secondary insurance.... Read more
Reader Questions:
Bill Retroactively for Uncredentialed ODs
Question: One of our optometrists is not yet credentialed with Medicare, and we have a Med... Read more
Reader Questions:
Prove Necessity for Gonioscopy
Question: Which diagnosis codes prove medical necessity for gonioscopy?Ohio Subscriber &n... Read more
Reader Questions:
Consider Time in Collecting for No-Shows
Question: Can our practice bill for no-show appointments? What are our legal rights as far... Read more
Reader Questions:
Understand Modifiers for Noncovered Services
Question: I'm about to send a bill to Medicare for a service I'm pretty sure will be denie... Read more
Case Study:
Think You've Mastered Glaucoma Coding? Test Yourself With This Scenario
" If you find yourself drowning in a sea of codes and modifiers, read on for a li... Read more
You Be the Expert:
Billing Aphakic Lens Materials
Question: When billing 92312 for a Medicare patient with aphakia, should I also bill the ... Read more
Quick Quiz:
Pick the Right Modifier to Report Post-Op Cataract Care
Test your after-surgery smarts and make sure you get every cent you deserve If you're lik... Read more
Think Twice Before Blinking During Contract Negotiations
13 tips will help you get the best deal from your vision plan carriers Insurance carriers... Read more
Answers to the Post-Op Care Quiz
1. C. Append modifier -55 (Postoperative management only) to the surgery CPT code to repor... Read more
Reader Questions:
Check State Rules for Records Copying
Question: We received a faxed request/authorization to release records to another physicia... Read more
Reader Questions:
Use Current Eye Condition for ICD-9 Code
Question: How should I bill BCBS for a routine exam with the diagnosis being post-keratopl... Read more
Reader Questions:
Continue Treatment Program for 92012-92014
Question: The guidelines in the CPT manual state that the intermediate and comprehensive e... Read more
Reader Questions:
Include Chart Review in E/M
Question: A patient had her past medical records, containing more than 10 years of history... Read more
Reader Questions:
Provide Copies to an Outside Auditor
Question: When our outside auditor gets copies of chart notes to perform an audit, the pat... Read more
Reader Questions:
Keep Display to a Minimum
Question: Our office has been told that having a patient sign-in sheet with the patient's ... Read more
Defeat Diagnostic Service Denials With Bulletproof Modifier Use
Do you know how Medicare wants you to bill serial tonometry done on both eyes? The answer ... Read more
Drag Your Carriers Out of Denial
Even small optometry practices can track denials - sharing info is keyIf you're not a watc... Read more
Know Carrier Rules for Bilateral Billing
 Appending modifier -50 to the wrong diagnostic eye codes can spark denialsHaving a l... Read more
You Be the Expert:
Provocative Tests for Glaucoma
Question: What testing and documentation do I need to bill for 92140 (Provocative tests fo... Read more
Recognize Any of These 'Top 10' Denials?
Rejections are preventable - if you educate your carriers about OD's work Our story on de... Read more
Reader Questions:
Educate Patients About Baseline Photo Necessity
Question: We offer our patients routine healthy baseline photos of the retina and disc. We... Read more
Reader Questions:
Apply Discount Policy Consistently
Question: Is it OK if we have a set exam fee and then offer a 15 percent discount to patie... Read more
Reader Questions:
Collect Extra for Deluxe Frames
Question: A patient comes in with insurance that covers 80 percent of the allowable amount... Read more
Reader Questions:
Use Patient Status to Determine E/M
Question: During an office visit, I performed an expanded problem-focused history, a probl... Read more
Reader Questions:
Avoid Bilateral Photos for Medicare
Question: Our new software program states to append modifier -50 to code 92250. Is that ap... Read more
Reader Questions:
Set Past-Due Policy in Stone
Question: Our in-house collections procedure is not as regimented as it could be. How many... Read more
Available Years:  2005  2004  2003