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Optometry Coding & Billing Alert

If You're Not Counting Techs' Work in Eye Exams, Read This
Their services can boost the E/M level --  if they-re following the incident-to ... Read more
Keep Modifiers in Line for Screenings and Refractions
Decide between GA and GY based on whether Medicare covers the service If you don't want t... Read more
Avoid Writing Off Every Physician Phone Call
Avoid Writing Off Every Physician Phone Call Almost every physician has to call another p... Read more
YOU BE THE EXPERT ~ Make Up Difference for Progressive Lenses
Question: I-m a little confused about coding for optical supplies. One of our patients got... Read more
READER QUESTION ~ Never Use E Codes as Primary Diagnoses
Question: I-ve never really understood E codes and when I should use them. Would you expla... Read more
READER QUESTION ~ Track Disease Progress With 92285
Question: We saw a patient after a scleral buckle procedure by another surgeon. The patien... Read more
READER QUESTION ~ Let Provider Steer Hospice Modifier
Question: When an optometrist who is a nonhospice provider performs a medical visit at a h... Read more
READER QUESTION ~ Tread Carefully When Using 367.9
Question: Will Medicare reimburse for 92004 or 92014 with the diagnosis  code 367.9?A... Read more
Capitalize on These Opportunities to Avoid 92135 Denials
Experts answer your top SLGT coding questions Optometrists are beginning to use scanning ... Read more
Reporting Each Foreign-Body Removal Separately? Not So Fast
FB removal coding depends on the site -- and sometimes on the carrier If a patient h... Read more
Familiarize Yourself With the Various SLGTs
Knowing what terminology to look for will help your coding To correctly code and bill for... Read more
Keep Your E/M Modifiers Straight With These Simple Tips
Assign 57, not 25, for E/M prior to a major surgical procedure Modifiers 24, 25 and 57 al... Read more
You Be the Expert ~ ICD-9 Reporting for Giant Papillary Conjunctivitis
Question: I-m trying to find a diagnosis code for giant papillary conjunctivitis. Since ... Read more
Reader Question ~ Observation Status Is Outpatient
Question: When providing a consult for a patient admitted to observation, should we report... Read more
Reader Question ~ Conduct 3 Tests Before Coding Diurnal Curve Encounters
Question: Is there a code for -diurnal curve testing,- in which the optometrist checks pre... Read more
Reader Question ~ Omit Modifiers for Incident-To Services
Question: Should I use a modifier when reporting services provided incident-to the optomet... Read more
Reader Question ~ Keep POS Straight for Rest Homes and Private Homes
Question: Our optometrist saw a patient for a brief visit in her home. I coded 99321 (Domi... Read more
Reader Question ~ Consider a Financial-Hardship Policy for Some Patients
Question: Is it OK for our practice to not collect a copay or deductible from a patient wh... Read more
Reader Question ~ State Guidelines Rule Most Workers' Comp Claims
Question: I am unsure about a workers- compensation claim. The patient, a traveling busine... Read more
Follow 3 Tips for Exemplary Extended Ophthalmoscopy Coding
Understanding the difference between EO and routine ophthalmoscopy is the key to avoiding ... Read more
New Patient Visits:
Same Group, Different Specialty--Collect What You Deserve
Stand your ground when a carrier shoots you down Watch out: It's time to fight for new pa... Read more
You Be the Expert:
Conjunctival Concretions
Question: I need a CPT Code for removal of conjunctival concretions. The optometrist fli... Read more
Earn Full Pay for Pre-Cataract Surgery Tests With Bulletproof Bilateral Coding
Improperly coding IOL Masters or A-scans can cost you $30 per patient Calculating intraoc... Read more
Reader Qustion:
Avoid Underpayment From SNFs With a Contract
Question: We consistently have trouble collecting for services our physicians provide to p... Read more
Reader Question:
Don't Try Low-Vision Codes on Medicare
Question: Our practice is considering dispensing low-vision aids. How should we code those... Read more
Reader Question:
Append Modifier 26 for VF Interpretation
Question: We did a visual field at the request of a primary-care physician for a patient w... Read more
Reader Question:
Find Your Medicare LCD in 1 Stop
Question: Where can I go to look up Medicare carriers- local coverage determinations? Also... Read more
Reader Question:
ABNs Can Protect the Practice With Private Payers, Too
Question: Are there any waivers for use when the physician provides an experimental and no... Read more
Not Appending Modifier 55 to Post-Op Cataract Management Claims? Read This
Communication with the surgeon can be the key to earning over $100 per patientYou may alre... Read more
Survive DMERC Audits For Post-Cataract Glasses
Keep these 6 forms on file for each Medicare eyeglasses beneficiary If your office is... Read more
You Be the Expert:
Epilation of Lashes
Question: What is the proper way to code for epilation of lashes? We used to bill per lash... Read more
News You Can Use:
Be Prepared for the RVU Changes That 2007 May Bring
Here's a checklist of what the future holdsThese are the times that try coders- and biller... Read more
Cash Flow Management:
Prepare for 9 Lean Medicare Days
5 strategies keep your cash flowing during September payment droughtIf your practice inclu... Read more
READER QUESTIONS:
Link 92250 to Ophthalmic Manifestation
Question: We submitted a claim for 99204 and 92250 to Medicare. The diagnosis code for bot... Read more
READER QUESTIONS:
Determine Lens Code by Who's Doing the Fitting
Question: What's the difference between the 92310-92313 series and 92314-92317? They look ... Read more
READER QUESTIONS:
If Doctor Cheats, Can Billers Be Charged?
Question: If an optometrist asked me to do something I knew was unethical or illegal--such... Read more
READER QUESTIONS:
Check Probate Status for Clues on Collecting
Question: About a week ago, a patient who owes our practice money died. Do you have any ad... Read more
Take 4 Steps to Fight for E/M Payment With Punctal Plug Insertion
Don't let faulty documentation take up to $120 out of your pocket You-ve coded what you-r... Read more
You Be the Expert:
Flashers and Floaters
Question: If a patient reports flashes and floaters and we do not find evidence of retinal... Read more
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Use This Letter to Win Appeals on Your Modifier 25 Claim Denials
 Tip: Don't forget to attach all supporting documentation The expression -actions sp... Read more
News You Can Use:
Prepare for Gain to E/M Codes And Loss to Most Other Codes
Higher-level E/M codes are biggest winners Not all evaluation and management codes will s... Read more
Go With EHR to Improve Billing Accuracy, Efficiency
Put legible records at your fingertips and watch compliance glitches disappear If you... Read more
Reader Questions:
Lash Out at Distichiasis Coding
Question: I am unable to find a diagnosis code for distichiasis. The patient had an eyelas... Read more
Reader Questions:
Could a New Problem Be a Consult Opportunity?
Question: A patient originally came to our office based on a referral for a procedure. The... Read more
Reader Questions:
Split Bill for Fundus Photos at SNF
Question: We performed fundus photos on a patient in a skilled nursing facility, and Medic... Read more
Reader Questions:
Don't Let Coverage Determine Coding
Question: Should we report exactly the same group of codes to all payers, or should we sub... Read more
Reader Questions:
Forget 'New Vs. Established' for Office Consults
Question: Should I report a consult for an established patient (whom we last saw two years... Read more
Reader Questions:
State Guidelines Rule Most Workers' Comp Claims
Question: I am unsure about a workers- compensation claim. The patient, a traveling busine... Read more
End Your E/M Vs. General Ophthalmological Services Codes Confusion
Use the 99200 codes for patients with specific problems -- but make sure your documentatio... Read more
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Make Sure Your E/M Documentation Measures Up
Use these handy definitions to determine if an E/M or eye code is more appropriate When y... Read more
Capture Missed Charges With Chart Audits
Prospective audits may be best if the office provides multiple services Optometry practic... Read more
News You Can Use:
Get a Head Start on the OIG's Modifier 25 Crackdown
Different-diagnoses stipulation may not apply to E/Ms and minor procedures If you-re look... Read more
You Be the Expert:
Corneal Topography
Question: What is the correct Medicare code for corneal topography? We used 92499 and were... Read more
Reader Questions:
Take Your ROS Up a Notch
Question: What is the difference between the -review of systems- (ROS) levels for the E/M ... Read more
Reader Questions:
Append TC for Baseline Retinal Photos
Question: I would like to offer baseline photos, taken with my fundus camera, for patients... Read more
Reader Questions:
PPOs Offer Members Greater Freedom Than HMOs
Question: What are the main differences between a preferred provider organization (PPO) an... Read more
Reader Questions:
Educate Staff Before E-Mailing Patients
Question: Our optometrist wants the office to begin using e-mail to contact our patients. ... Read more
Insurance Dilemma:
Seeing Patients With Both Medicare and Routine Vision Coverage? Read This First
Use the patient's chief complaint and history of present illness to decide who gets the bi... Read more
Try This Approach to Ease Patient Confusion
Make sure staff explains the difference between -routine- and -medical- up front A patien... Read more
Consult Confusion Just Got More Tangled
You need not verify documentation, but it should be there Optometrists who perform consul... Read more
Check Out These Carrier Rules To Escape the VF Catch-22
You may be able to report an unlisted-procedure code for a taped visual field test When a... Read more
Don't Write Off Low-Income Copays Until You Get the Facts
Good news: Your state may cover copays, even for non-Medicaid patients If your practice ... Read more
You Be the Expert:
External Ocular Photography
Question: Our optometrist is interested in code 92285. What are the guidelines for reporti... Read more
Reader Questions:
Use E/M Code for Toxicity Exam
Question: One of our patients was told by her doctor to see an eye doctor annually because... Read more
Reader Questions:
Look for Bleb Infection Codes in 2007
Question: A therapeutic optometrist in our office heard that there would be some new diagn... Read more
Reader Questions:
Should Non-Par Providers Still Collect Copays?
Question: Do we have any obligation to try to collect copays or deductibles when we are no... Read more
Reader Questions:
Code After-Hours Emergency With 99050
Question: The optometrist returned to the office at midnight to see a patient with an emer... Read more
Reader Questions:
Paper Claim Doesn't Have to Mean Slow Filing
Question: Our payer says we are not in compliance with -timely filing- requirements when w... Read more
Reader Questions:
Capture HPSA Bonus With Exact Visit Location
Question: Our practice is in a rural area, but we don't always receive an HPSA bonus when ... Read more
Reader Questions:
Do You Need a Shredder Strong Enough for CDs?
Question: Our optometry office is researching document shredders before purchasing one. Wh... Read more
Using Diagnosis to Determine Your VF Code? Read This First
Depending on the stimulus, you may be able to bill an extended exam--and bump pay to $74 e... Read more
Deploy V Codes for Victorious Plaquenil Exam Coding
Tip:  Use underlying condition as secondary diagnosisWhen you-re checking a patient's... Read more
Alternate VF and SLGT to Keep Carriers Happy
Medicare prefers visual fields for patients with advanced glaucoma damageTwo of the best w... Read more
Compliance Corner:
Look Past Minimums for Records Retention
Why observing the 6-year federal requirement may not be adequateBefore you toss those reco... Read more
You Be the Expert:
Emmetropia Diagnosis
Reviewed May 18, 2015 Question: A patient has a diagnosis of -emmetropia.- A colleag... Read more
Billing Basics:
Don't Play Percentages With Overdue Copays
Watch out for state, federal laws on charging patients interestDealing with patients who d... Read more
Correction
An article in the March 2006 Optometry Coding & Billing Alert, -Dodge DMERC Denials Wi... Read more
READER QUESTIONS:
Use Patient Complaint for FBR Coding
Question: I saw a patient yesterday who had a conjunctival foreign body. I billed 65205 an... Read more
READER QUESTIONS:
Head Off Copay Problems With Phone Work
Question: We are in the midst of a copayment crisis. In the past month, we have had four p... Read more
READER QUESTIONS:
Find Diabetic Manifestation for Dx Code
Question: What diagnosis code should we use when billing a diabetic patient who needs phot... Read more
READER QUESTIONS:
Expect Denials for New Photoscreening Service
Question: I received a notice from our carrier that it would not reimburse for -ocular pho... Read more
READER QUESTIONS:
Do Your Research to Find Best Biller for You
Question: What are some of the pros and cons of a medical office outsourcing its billing o... Read more
READER QUESTIONS:
Properly Document Updated Patient History
Question: Are there any official coding rules or regulations that state how often a patien... Read more
Smile for the Camera and Revitalize Your Fundus Photography Coding and Billing
Getting fully reimbursed for 92250 is a snap--if you know the bundling and bilateral rules... Read more
Quick Quiz:
Test Your Scanning Laser Coding Skills
You're 5 questions away from finding out if you've mastered SLGT billingIt's still a relat... Read more
Think You Can Bill E/M With Every Test? Think Again
Don't code 99201-99215 separately unless the service can stand aloneIf you-re automaticall... Read more
Craft a New Billing Policy in 6 Steps
This easy policy-writing tutorial will guide you from start to finishThe key to optometry ... Read more
Here's Who to Call to Get Appeals Settled Faster
Some carriers require redeterminations even for minor errorsThe new and improved appeals p... Read more
READER QUESTIONS:
Distinguish Between 92012 and 92014
Question: When is it appropriate to use 92012 as opposed to 92014? Virginia Subscri... Read more
Are You Required to Report Both Wrongful and Incidental Disclosures?
Question: What is the difference between a wrongful and an incidental disclosure of protec... Read more
READER QUESTIONS:
Anticipate Rate Reversal, Retroactive Payment
Question: Will I need to resubmit the claims I have submitted in 2006 to claim the correct... Read more
READER QUESTIONS:
Release Contacts Rx Regardless of Prior Bills
Question: After an eye exam and refraction, the patient wanted a copy of his contact lens ... Read more
READER QUESTIONS:
Solve the Consult-Versus-Referral Riddle
Question: What is the difference between a consultation and a referral, and how can I tell... Read more
You Be the Coder:
Ocular Blood Flow Testing
Question: What is the correct code for ocular blood flow (OBF)? A sales rep told me that i... Read more
Dodge DMERC Denials With Crystal-Clear Refractive Lens Coding
Modifiers KX and EY are the keys to reimbursement--but don't forget GAWhen a patient comes... Read more
You Be the Expert:
Scanning Laser With E/M Service
Question: I recently received a denial for a scanning laser test performed with an E/M vis... Read more
Fix Errors Before They Derail Your DMERC Claims
Be sure to inform Medicare beneficiaries of the supplier standardsDispensing vision suppli... Read more
News You Can Use:
Add Hispanics 65 and Older To Glaucoma Screening Benefit
Now 4 at-risk groups qualify for G0117 and G0118In 2006, you need to ask one more question... Read more
2006 RVU Update:
Hold the Fees for Your 2006 Services at 2005 Levels
Pay-for-performance program is looking a lot less likelyOn Feb. 1, the U.S. House of Repre... Read more
Protect Your Consult Reimbursement
Doctors can request consults from others in the same group.You may have spotless documenta... Read more
OIG Alert:
Reserve Modifier 25 for Separate E/M History, Exam MDM
Only reporting 1 code?  Hold the modifiers!The OIG is encouraging CMS- Part B carrier... Read more
READER QUESTIONS:
Append GY to Refraction Claims
Question: A doctor recently told me that appending modifier GY to the refraction code woul... Read more
READER QUESTIONS:
Train Staff for Unannounced Audits
Question: I hear so many horror stories about billing offices that fall apart and make dis... Read more
READER QUESTIONS:
Record Medicare Patient's Exact Card Data
Question: We-ve been receiving numerous Medicare claim denials recently, and there doesn't... Read more
READER QUESTIONS:
List Payment Modifiers Before LT and RT
Question: When I append multiple modifiers to a CPT code, is there any rule about the orde... Read more
READER QUESTIONS:
Save Calendars to Support Incident-To Claims
Question: What evidence or documentation do we need to prove the supervising physician was... Read more
Myth Buster:
Document the Location, Patient Complaint for Foolproof Foreign-Body Removal Claims
Treating punctal plugs like FBRs? Read this first Even more irritating than having someth... Read more
You Be the Expert:
Diplopia and Sixth Nerve Palsy Dx
Question: I had a patient present with a complaint of diplopia. When I examined him, I fou... Read more
News You Can Use:
Expect Action on Medicare Payments After Jan. 31
Even if your payments are restored retroactively, will you be able to collect? While Cong... Read more
Collections Corner:
No-Show Charge Is a No-No Without Patient Notification
Many optometry offices give patients 1 -free- no-show When a patient fails to show up for... Read more
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Keep Track of Bilateral Status
Find answers for your bilateral billing questions for common optometry procedures Keeping... Read more
Reader Questions:
Report Quantity Defects Strategy With 92082
Question: I understand that a visual field screening is 92081, and a 30-2 full-threshold e... Read more
Reader Questions:
Look to 92225 for Goldmann-3
Question: Is 92020 the correct way to code for a Goldmann three-mirror exam? The examinati... Read more
Reader Questions:
Don't Worry About Unsigned Superbills
Question: What happens if the patient does not sign the superbill after his encounter? Are... Read more
Reader Questions:
Use GA for Uncertain Post-Cataract Claims
Question: A patient presented for an exam three years after cataract surgery on both eyes.... Read more
Reader Questions:
Take 3 Steps That May Prevent an Appeal
Question: Do I have to file an appeal every time I make a mistake on a claim? Are there an... Read more
Reader Questions:
Attach 59 by Code Designations
Question: Should I always append modifier 59 to the lower-valued code of an NCCI bundle?Wa... Read more
NCCI 12.0 Update:
Include Eye Exams in Nursing Home Visit Codes
The E/M codes may have changed, but the bundles remain the same for optometrists servicing... Read more
You Be the Expert:
Scanning Laser With Office Visit
Question: Our practice has recently purchased a GDx. We are going to offer the use of this... Read more
Earn $136 for Corneal Topography With Clean Coding
You can bill the procedure for patients with surgically-induced astigmationIf your office ... Read more
News You Can Use:
Find Coding Info Faster With New and Improved CMS Web Site
CMS hopes new site will be 'easier to browse by audience or topic'Mention the Medicare Web... Read more
Billing Basics:
Do Your Best Intentions Cause Compliance Nightmares?
Plus: 15,000 reasons 'professional courtesy' is bad for businessWith insurance restri... Read more
Determine Financial Hardship to Justify Discounts
For tough cases, don't dispense glasses until your payment is in handYou-ve played by the ... Read more
State Law Governs Commercial Carrier Refunds
Question: We billed a non-contracted carrier based on coverage information the patient pro... Read more
READER QUESTIONS:
Bill Primary First, Even As Non-Par
Question: Medicare has denied a claim stating that another payer is primary. That payer is... Read more
READER QUESTIONS:
Ask This When Outsourcing
Question: My practice is thinking about outsourcing our billing. What should I look for in... Read more
READER QUESTIONS:
Don't Count on Cash for Education
Question: Is there a way we can offset the cost of educational materials, pamphlets, etc.,... Read more
Available Years:  2006  2005  2004  2003