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Optometry Coding & Billing Alert

Breeze Through Allergy Season With Specific Eye Irritation Dx
Use these tips to get the most specific diagnosis you can for your eye irritation patients... Read more
E/M Corner:
3 Tips Are Key to Deciphering 99213 From 99214
Avoid these upcoding mistakes.Do you recognize when an optometrist documents a 99214 but o... Read more
You Be the Expert:
FB Removal and E/M
Question: A patient with eye pain presented to our office. This is a Medicare patient our ... Read more
Build a Better Business:
Not Issuing Refunds? You May Be Asking for Trouble
Keeping overpayments can get you in hot water with patients and payers.If you haven't deal... 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:
Expect Less From Medicare if Doc Owes the IRS
Question: My optometrist owes back taxes to the IRS. A colleague warned him that the IRS c... Read more
Reader Questions:
Collect Copays Even if You're Non-Par
Question: Do we have any obligation to try to collect copays or deductibles when we are no... Read more
Reader Questions:
Medicare Considers Interpreter Service 'Incidental'
Question: Which diagnosis code should I use with T1013 for using an interpreter with a Med... Read more
Reader Questions:
Avoid Bilateral Modifiers on 76519, 92136
Question: The optometrist calculated IOL power in both a patient's eyes. Should I report t... Read more
Look to Modifiers KX, EY for Keys to DME Reimbursement
Keep medical necessity distinct from patient preference in your documentation.If you're pr... Read more
DME MACs Usually Won't Cover These
There are a few HCPCS codes that your DME MAC will never cover. Make sure that the Medicar... Read more
PQRI:
3 Simple Solutions to Ease PQRI Pay Frustration
Hint: Your vendor is interested in helping you maximize your return.If you were one of the... Read more
News You Can Use:
OIG to Focus on Unlisted Procedures, Modifier GY
Make sure you're not 'covering' for noncovered services.Next year you'll want to make sure... Read more
Don't Rule Out Billing if Documentation Is Missing
3 steps ensure you're using compliant documentation.Every biller comes across this situati... Read more
You Be the Expert:
VFs Ordered by Outside Doctor
Question: We performed a visual field ordered by a doctor outside our practice. The patien... Read more
Clarification:
Comprehensive Exams Don't Always Include Dilation
A Reader Question in Optometry Coding & Billing Alert, Vol. 6, No. 7, "Distinguish Bet... Read more
Reader Questions:
Describe Follow-Up Visits Accurately With V Codes
Question: If a patient receives treatment and the condition was resolved, which ICD-9 code... Read more
Reader Questions:
Exophthalmometry Included in Eye Code
Question: Is there a CPT code for exophthalmometry?Georgia SubscriberAnswer: CPT considers... 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:
CMS Offers You an ABN Reprieve
Question: Our practice has struggled to implement the new ABN form. The deadline was Sept.... Read more
Reader Questions:
Duplicate Claims Submission
Question: We have several claims that our payer is taking more than 30 days to process or ... Read more
E/M or Eye Code? Choose Wisely With These Documentation Tips
Use the 99200 codes for patients with specific problems -- but make sure your documentatio... Read more
You Be the Expert:
Schirmer's Test
Question: Is there a code for a Schirmer's tear test other then the generic 92499? I have ... Read more
Here's How to Ensure That Your E/M Documentation Measures Up
Use these definitions to make sure your coding matches the level of service you provideWhe... Read more
4 Scenarios Clear Up Your Multiple FB Questions
Foreign body removal coding depends on the site -- and the carrierIf a patient has multipl... Read more
2 Tips Help You Rev Up Referrals
Result: Healthier, happier patients, and a more profitable practiceReferrals are key to go... 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:
Append GY to Refraction Claims
Question: A doctor recently told me that appending modifier GY to the refraction code woul... Read more
Reader Questions:
Don't Confuse PAM With VEP
Question: Is 95930 the correct procedure code for potential visual acuity meter? Can this ... Read more
Reader Questions:
Billing Before Credentialing -- When Is It a No-No?
Question: Our practice is expanding and we will soon have two new optometrists starting wh... Read more
Reader Questions:
Learn the Do's and Don'ts of Setting Fees
Question: We have several patients who are cash/self-pay patients without insurance. We wo... Read more
Defeat Ophthalmic Diagnostic Service Denials With Bulletproof Modifier Use
Do you know how Medicare wants you to bill bilateral OCT? The answer could be worth $44 ... Read more
Clarification:
Check Your State's Regulations Before Billing WC Claims
An established patient may not actually always be a new patient When you-re billing a w... Read more
VEP Tests on Nonverbal Patients? Look to 95930
You may find better amblyopia testing results -- and more steady payment Optometrists w... Read more
You Be the Expert:
Giant Papillary Conjunctivitis
Question: I-m trying to find a diagnosis code for giant papillary conjunctivitis. Since ... Read more
Build a Better Business:
Verify Coverage Even After Rendering Service
Adopt the 'better late than never' policy rather than not verifying at allMost experts wil... Read more
Reader Questions:
Learn the Trick to Distichiasis Coding
Question: I am unable to find a diagnosis code for distichiasis. The patient had an eyel... Read more
Reader Questions:
Report Humphrey 10-2 Test as 'Extended' VF
Question: We now use procedure code 92083 for a 30-2 visual field. We think we should also... Read more
Reader Questions:
Look to Your Contract for Help With Termination
Question: My practice is considering terminating a contract with one of our payers and bec... Read more
Reader Questions:
Avoid Record Withholding as a Collections Effort
Question: A patient who owes us a lot of money is now seeing a new eye doctor who has requ... 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
Document Medical Necessity to Solidify Your OCT Billing
Bonus: Learn when you can -- and should -- report 92135 more than once When an optometr... Read more
Understand Eyelid Modifiers and Avoid Coding Confusion
Do you need E1-E4 for punctal plugs and epilation? Thanks to the abundance of bilateral... Read more
Fast Facts on 92135
OCT stands for "optical coherence tomography," and it's also sometimes called a retinal th... Read more
Is Lack of Verification Costing Your Practice? Stop the Bleeding
Implement an eligibility check before the patient comes into your office Verifying insu... Read more
You Be the Expert:
Monitoring Drug Effects
Question: A primary-care physician instructed one of our patients to see an eye doctor a... 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 ... Read more
Reader Questions:
Look at 371.6X for Keratoconus Patient
Question: What would the correct diagnosis codes be for an exam with the diagnosis post-... Read more
Reader Questions:
Age Is a Factor in Financial Responsibility
Question: We have a patient who is covered by his mother's insurance, but he is over 18.... Read more
Reader Questions:
It's Not Too Late to Participate in PQRI
Question: Our optometry practice did not begin the Physician Quality Reporting Initiativ... Read more
Reader Questions:
Don't Ignore Patient Status for WC Claims
Question: An optometrist in our practice said that if an established patient comes in fo... Read more
Prove Medical Necessity for Fitting Contacts and Earn $65 Each Time
92310 won't cut it for keratoconic patients -- but this strategy will You know you can'... Read more
News You Can Use:
Documentation Errors Cost Practices $1.3 Billion in 2007
Insufficient documentation may cost optometrists over $17 million Can't seem to get you... Read more
Build a Better Business:
Avoid Collection Hassles by Getting the Lowdown on HSAs
First step: Review all payer agreements The number of patients with health savings acco... Read more
You Be the Expert:
Negative Glaucoma Screening
Question: A patient referred to our office had high intraocular pressure, and the optome... Read more
Reader Questions:
Distinguish Between 92012 and 92014
Question: When should I use 92012 rather than 92014? Virginia Subscriber Answer: The... Read more
Reader Questions:
Conduct 3 Tests Before Coding Diurnal Curve Encounters
Question: Is there a code for "diurnal curve testing," during which the optometrist chec... Read more
Reader Questions:
Is 'Professional Courtesy' Really Illegal?
Question: The optometrists in my practice have asked me whether they can offer professio... Read more
Reader Questions:
Get the Red Out on Foreign-Body Dx Codes
Question: A 16-year-old boy presented with a scratchy sensation from a foreign body in h... Read more
Reader Questions:
Unbundle Slit Lamp Photos and Gonioscopies
Question: Our optometrist saw a glaucoma patient and performed a gonioscopy. The optomet... Read more
Reader QUESTIONS:
9 Digits May Zip Up Reimbursement
Question: We are getting denials from Medicare saying they can't see box 32 in our claim... Read more
Do You Know the Secrets of Full Reimbursement for IOL Power Calculations?
Improperly coding IOL Masters or A-scans can cost you almost $30 per patient Calculatin... Read more
Don't Stop at 4 Digits for IOL Master Diagnosis
To prove medical necessity, you must get specific -- or risk denials Medicare covers IO... Read more
News You Can Use:
Eliminate NEMB Jumble With New ABN
Update now if you-re not already using the revised form for refractions If your practic... 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 la... Read more
Capitation May Be on the Horizon:
Get Ready
Find out whether capitation will help -- or harm -- your practice If you thought you wo... Read more
Reader Questions:
Modify Eye Codes Just Like E/M Codes
Question: Can we append modifiers 25 or 57 to the eye codes 92002-92014? The description... Read more
Reader Questions:
File Secondary Claims to Foster Patient Relations
Question: A patient's primary insurer is Medicare, and she also has secondary insurance.... Read more
Reader Questions:
Don't Change Insertion Code by Plug Type
Question: Our optometrist uses both temporary and permanent punctal plugs. Should I code... Read more
Reader Questions:
Document Complaint for Glaucoma Follow-Up
Question: How should I code an office visit for a wheelchair-bound nursing home patient ... Read more
Reader Questions:
Get a Handle on Timely Filing Date Rules
Question: What is the best way to handle a claim that is past the timely filing date for... Read more
News You Can Use:
Focus on Specifics With New ICD-9 Codes for Retinopathy of Prematurity
Proposed diagnosis codes would break down ROP by stages Good news for optometrists seei... Read more
End 'Medical vs. Vision' Insurance Confusion
When your patient has both types of insurance, who gets the bill? A patient presents fo... Read more
Are You Within the National E/M 'Bell Curve'? Find Out
Audit alert: If your billing pattern differs too much from Medicare statistics, you coul... Read more
You Be the Expert:
Split Postoperative Cataract Care
Question: An ophthalmic surgeon performs cataract surgery, and then turns the patients o... Read more
Build a Better Business:
New Software Can Solve Medicare Secondary-Payer Woes
Good starting point: Turn to a clearinghouse for help If you-re wrangling with your car... Read more
Reader Questions:
Add Modifier 52 for Unilateral VF
Question: I-m confused about coding for visual fields (VF). The code description says "u... Read more
Reader Questions:
Beware Reporting Fundus Photos With HRT
Question: Can I report a fundus photo and a Heidelberg retina tomograph (HRT) on the sam... Read more
Reader Questions:
Check CCI Bundles With A-Scans
Question: Can I code both the A-scan (76519) and corneal topography (92025) together if ... Read more
Reader Questions:
Include V58.69 on Plaquenil Checks
Question: A patient taking Plaquenil for her arthritis needs to have her eyes monitored ... Read more
Reader Questions:
Don't Expect to Get Paid on 99050
Question: Where can I find the allowed charge amount for after-hours appointment code 99... Read more
Reader Questions:
Dig Into Dry Eye Diagnoses
Question: Should I report a dry eye diagnosis code based on my clinical findings or the ... Read more
Snap Up Your Rightful Fundus Photo Pay With Bundling, Dx Know-How
Appending modifier 50 to 92250? Not so fast Adding too many -- or too few -- codes to y... Read more
Master Optometry Diagnosis Coding in 3 Easy Steps
Hint: Medical necessity is not necessarily top priority If your diagnosis coding fails ... Read more
You Be the Expert:
Report Glaucoma Screenings for Medicare
Question: A patient with controlled type II diabetes and a family history of visual loss... Read more
Prepare Now for Potential Mid-Year Medicare Fee Cuts
Make the most of PQRI reporting to bring in extra payment Finding ways to streamline fi... Read more
Reader Questions:
Medicare Uses B3 for Second Claimant
Question: What does the B3 on a patient's Medicare card stand for? Colorado Subscriber ... Read more
Reader Questions:
Avoid Sending 1099 to Patients for a Bad Debt
Question: We ended up writing off some patient balances as bad debts. Should we be sendi... Read more
Reader Questions:
J2001 Is No-Go for Minor In-Office Procedures
Question: Is there a code we should bill for subcutaneous lidocaine or lidocaine with ep... Read more
Reader Questions:
Keep Training Records on File
Question: Does the privacy rule mandate that we keep our training documentation, such as... Read more
Reader Questions:
Say No to 378.xx for Pseudostrabismus
Question: What ICD-9 code should I report for a diagnosis of pseudostrabismus? Arizona ... Read more
Reader Questions:
Aim for Proper Ametropia ICD-9 Code
Question: Which ICD-9 code should I report for ametropia? Kansas Subscriber Answer: ... Read more
Reader Questions:
FTP Is Legal but Isn't Best Option
Question: Our staffers want to use file transfer protocol (FTP) to send patients- confid... Read more
Reader Questions:
Don't Add Unnecessary Digit to 368.8
Question: Lately all of our claims with diagnosis code 368.80 for blurred vision have be... Read more
Reader Questions:
Simplify by Using Separate NPP Forms
Question: When a mother brings her four children to our optometry practice for the first... Read more
6 Tips Guide You to More Accurate
Clear the air on appropriate codes to boost practice revenue Getting insurance claims p... Read more
Learn the Latest on CPT's Possible Consult Clarification
Get to know the 5 consultation keys -- we-ll tell you what they are Rumors had circulat... Read more
You Be the Expert:
Look for Long-Standing Strabismus Case Code
Question: Another OD referred a new patient with long-standing strabismus to us. How sho... Read more
Build a Better Business:
3 Basic Items Guarantee Successful Contract Negotiation
If you want to keep your practice running smoothly and successfully, you have to know the ... Read more
Reader Questions:
Put Progressive Lens Billing Questions Behind You
Question: We fitted a patient for progressive lenses. How should we bill the procedure? ... Read more
Reader Questions:
E/M Applies for Patient-Generated Second Opinion
Question: A patient recently visited our clinic and asked for a second opinion. CPT has ... Read more
Reader Questions:
Look at Transferring Patient's Time Frame
Question: An optometrist is new to our practice from another practice in town. Some of h... Read more
Reader Questions:
Don't File PRK Follow-Up by Second Optometrist
Question: We got a patient for a PRK follow-up exam. He had the surgery done at another ... Read more
Reader Questions:
Get Ready for 'UHC Meets CCI'
Question: I-ve heard that I-m going to have to start changing some of the codes that I b... Read more
Reader Questions:
Watch for Phone Code Fine Print
Question: A new patient with blurry vision came to our office on Wednesday. I did a comp... Read more
Reader Questions:
Check Fee Schedule for Punctal Plug Global Period
Question: What is the postoperative period for punctal plug insertion? I am planning to ... Read more
Reader Questions:
Use a BAA for Electronic Claims Submission
Question: We are moving to electronic billing but now submit paper claims. Do we need to... Read more
Go Beyond Routine Coding for Extended Ophthalmoscopies
Ensure you know what qualifies as an EO before adding 92225-92226 to another claim Most... Read more
3 FAQ Answers Clear Up Your Gonioscopy Confusion
Key: Get to know payer-specific rules before adding 92020 to another claim With only on... Read more
Build a Better Business
Streamline your collections system and get your deserved money faster with these tips on... Read more
Expert Advice to Eliminate Copay Collection Hardships
Smart steps to ensure you get your hard-earned dollars Getting copays from your patie... Read more
You Be the Expert:
Take the Bilateral SLGT Challenge
Question: We used SLGT on a patient to test for glaucoma. We performed the test on both ... Read more
Reader Questions:
Separate Notes Prevent Workers' Comp Denials
Question: We have a patient who comes in for one diagnosis for his workers- comp coverag... Read more
Reader Questions:
Avoid Billing Trouble While Treating Minors
Question: A minor child with a small injury presented to our office. The patient lives w... Read more
Reader Questions:
Ditch Denials for E/M With Punctal Plug Insertion
Question: A patient came to us for punctal plug insertion. He also complained about pain... Read more
Reader Questions:
Just Say No to 'Rule-Out' Diagnosis Coding
Question: Is it OK for me to report those conditions I-m trying to rule out as the diagn... Read more
Reader Questions:
Tech or Physician? You Need to Know for CL
Question: I have a question about coding my contact lens fittings. The two code sets for... Read more
Check Method, Location for Correct Coding on Eye FBRs
Doctors might need slit lamp on some corneal FBRs Coding for an ocular foreign-body rem... Read more
Answer 'Separate' or 'Inherent' Question Before You Use Modifier 25
When an optometrist performs an E/M service and a procedure on the same patient during the... Read more
You Be the Expert:
Diagnosis Coding for Damaged Ducts
Question: I am having trouble finding the proper diagnosis code for this claim. The opto... Read more
Follow Locum Tenens Rules for Sub Doctors
Modifier Q6 a must for substitutes When one of your optometrists takes a leave of absen... Read more
Billing Question:
New OD Doesn't Mean New Patient
Question: We have a new optometrist in our group whose patients from his previous group ... Read more
Reader Questions:
Find Medical Problem in Patient's Good Eye
Question: A patient with one good eye and one prosthetic eye came in for a yearly check.... Read more
Reader Questions:
Blepharitis Type Drives Diagnosis Coding
Question: What is the proper ICD-9 code for patients with blepharitis? Tennessee Subscr... Read more
Reader Questions:
Count on Full Pay per Eye for 92235
Question: Can I report 92235 times two, bilateral eyes for each visit? California Subsc... Read more
Reader Questions:
Coding Observations? Forget About Location
Question: Our optometrist performed an observation service on a patient who was not in t... Read more
Reader Questions:
Modifier 76 Can Help You Avoid Repeat Denials
Question: How should I report a service that the optometrist performs more than once in ... Read more
Reader Questions:
Medicare Makes Face-to-Face a Must on Consult
Question: What is the best way to code for a family consult when the patient is not pres... Read more
Reader Questions:
Check Column T for Bilateral Answers
Question: Our optometrist performed fundus photography on both eyes for a Medicare patie... Read more
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