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Optometry Coding & Billing Alert

FBR:
65205-65222: Location, Number Determines Correct Foreign Body Removal Code
Don’t automatically code each FB separately, say experts. If a patient has multi... Read more
CCI:
Modifiers 24 And 57 Will Soon Allow You to Bypass CCI Edits
Plus: You can also override bundles with modifiers LM and RI We’ve all heard the... Read more
CMS News:
Update Your Revalidation Plan With New CMS Instruction
Kinder, gentler process forestalls ‘revocation.’ Don’t lose your abi... Read more
Modifiers:
Answer 'Separate' or 'Inherent' Question Before You Use Modifier 25
Not all pre-procedure services constitute a separate E/M. When an optometrist performs... Read more
E/M Coding:
Implement These 5 Simple Tips to Boost Your E/M Bottom Line
Heads up: Dig past ‘follow-up’ for acceptable chief complaint. E/M coding ... Read more
You Be the Expert:
Post-FBR Patient
Question: One of our optometrists uses a slit-lamp to check on healing after a foreign-b... Read more
Reader Question:
92133 or 92134 Answers Nonconclusive HRT Question
Question: How should I code for a nonconclusive HRT? One of our patients had one done, b... Read more
Reader Question:
New Year, New Insurance = New Verification
Question: How should I file a claim on a patient who has new coverage but has not receiv... Read more
Reader Question:
Get Patient's Signature on Records Transfers
Question: We were forced to discharge a patient. She paid for a copy of her medical reco... Read more
Contact Lenses:
92310-92317: Condition, Provider, Bilateral Status Drive Your Lens Claims
Let these 6 tips guide you to more accurate contact lens claims. Insurance carriers can... Read more
Billing Corner:
Learn the Ropes of 5 Common Audits Your Practice May Face
Learn the Ropes of 5 Common Audits Your Practice May Face If you are getting confused b... Read more
ICD-10:
Your Transition Plan Should Encompass 6 Phases, Expert Says
A working budget should include every aspect of pla You may have put ICD-10 planning on... Read more
Modifiers:
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
You Be the Expert:
Slit Lamp Photo and Gonioscopy
Question: Our optometrist saw a glaucoma patient and performed a gonioscopy. The optomet... Read more
Reader Question:
Remember ABN for Low-Risk Glaucoma Screenings
Question: Our office sometimes performs glaucoma screenings for patients who don't meet ... Read more
Reader Question:
92226 Requires Proof EO Is Actually Extended
Question: I just got a denial on 92226. I think I might be using this code incorrec... Read more
Evaluations:
Determine the Difference Between Intermediate and Comprehensive Exams
Other options include E/M and S-codes, but choose wisely.CPT® divides general ophtha... Read more
Billing Corner:
No-Shows? No Problems With These 4 Expert Tips
No-show fees are one approach, but beware the PR backlash.These days every dollar and ever... Read more
News You Can Use:
Get Used to Revalidation Process, Medicare Warns
Plus: CMS will begin accepting faxed, emailed supporting documents.If CMS's revalidation p... Read more
Correction:
Correction:
The article "92134 Basics: Avoid These Pitfalls and Keep OCT Coding on Track," in Optometr... Read more
You Be the Expert:
Visual Fields for Glaucoma Suspect
Question: We keep getting denials for 92082 and 92083 (Visual field examination ...) linke... Read more
Reader Question:
92226 Requires Proof EO Is Actually Extended
Question: I just got a denial on 92226. I think I might be using this code incorrectly. Ca... Read more
Reader Question:
Be Sure to Send Overpayments Back to Insurer
Question: I just recently went to a seminar and the instructor informed us that we should ... Read more
Diagnostic Tests:
92133 Basics: Avoid These Pitfalls and Keep OCT Coding on Track
Documentation, modifiers, and knowing your bundling rules can be worth nearly $45 each tim... Read more
Punctal Plugs:
Fight Back Punctal Plug Denials With These 4 Steps
Hint: Make sure to check your documentation and the payer's policy.You've coded what you'r... Read more
Billing Corner:
Collections: Capture Some Reimbursement for No-Show Visits With 4 Tips
Beware of the public relations affect no-show fees may have on your practice.These days ev... Read more
News You Can Use:
Double-Digit Cuts May Strike Your Income Starting in January
Some specialties will be hit hard, unless Congress steps inEvery year around this time, th... Read more
You Be the Expert:
Conjunctival Concretions
Question: I need a CPT® code for removal of conjunctival concretions. The optometrist fl... Read more
Reader Question:
Report Unrelated Fundus Photos Without Modifier
Question: We have a patient still in the global postoperative period for cataract surgery.... Read more
Reader Question:
ICD-9 Freeze Will Spare You New Updates This Year
Question: Are there any ICD-9-CM updates planned for 2013? Iowa Subscriber Answer: No ICD-... Read more
Reader Question:
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
Diagnostics:
Modify Diagnostic Tests Correctly, or Prepare to Lose Big Money
Keeping bilateral modifiers straight can be worth as much as double the reimbursement.Diag... Read more
ICD-10 Outlook:
AMA and Provider Feedback Impact ICD-10 Delay
Don't let changes catch your ophthalmology practice by surprise.CMS hasn't made a final an... Read more
Billing Corner:
Overcome Primary vs. Secondary Payer Woes With Answers to Your FAQs: Part 2
Tackle payment errors like a pro with this advice.Collecting payment for patients who are ... Read more
Reimbursement:
3 Outdated Billing Habits You Must Overcome Now
You may already be struggling with denials for these issues -- update your processes ... Read more
Reader Questions:
67820 Covers Epilation of Lashes
Question: What is the proper way to code for epilation of lashes? We used to bill per lash... Read more
Reader Questions:
92015-92140 and 92002-92014 Can Mix
Question: Can the special ophthalmological services be provided and reported with the gene... Read more
You Be the Expert:
92012 or 92014?
Question: When is it appropriate to use 92012 as opposed to 92014?Virginia SubscriberAnswe... Read more
Glaucoma Screenings:
Choose Wisely Between S Code and G Code for Glaucoma Screening
Let form and severity drive your glaucoma coding choices.If your practice is like most op... Read more
Healthcare Reform:
Affordable Care Act Already Having Effect
Our expert weighs in with her views.In the wake of the U.S. Supreme Court's ruling upholdi... Read more
Denial Management:
Make Sure Optometrists Are Listed Under Correct Specialty Code
Medicare contractor reports confusion over specialty codes leads to denied claims.If you r... Read more
Compliance:
Are You Watching Your E/M Trends? OIG Is
Inspectors are finding higher use of high-level E/M codes.If you examine your practice's E... Read more
Is Your Glaucoma Patient Truly at High Risk?
Medicare and most commercial insurances cover annual glaucoma screenings for high-risk ind... Read more
You Be the Expert:
Refraction for Medicare Patient
Question: A Medicare patient came in just to have his prescription updated. If I only perf... Read more
Reader Question:
Nursing Home Patient -- Eye or E/M Code?
Question: I visited a patient who was in a nursing home. Should I use an eye exam code or ... Read more
Reader Question:
95930 Describes VEP Test
Question: Is 95930 the correct procedure code for potential visual acuity meter? Can this ... Read more
Reader Question:
No CCI Bundle? Here's Where to Find Modifier Details
Question: Sometimes I cannot find my two-code pair in the CCI edits. How do I know which c... Read more
Reader Question:
Catch Up on Incomplete Claims
Question: Our practice has a few claims that have missing or incorrect information. I'm no... Read more
Post-Op Care:
5 Steps to Cataract Care Claims Success
Keep your eye on modifiers and diagnosis codes. Providing postoperative care to a cataract... Read more
Diagnostics:
92250 Survival Guide: Keep These Tips in Your Fundus Photo Toolbox
Don't miss legitimate opportunities in glaucoma visits.Fundus photography is a critical to... Read more
Billing Basics:
Avoid 10 Common Billing Errors With 10 Expert Tips
Hint: Benefits verification can solve a lot of your denial problems.What's the top tool in... Read more
Audits:
Prepare Your Practice for 5 Common Audit Types
Avoid RAC trap for bilateral procedures.If it seems like audits are coming at your optomet... Read more
You Be the Expert:
Diurnal Curve Testing
Question: Is there a code for "diurnal curve testing," in which the optometrist checks pre... Read more
Reader Question:
92225 Reflects Goldmann-3 Exam
Question: Is 92020 the correct way to code for a Goldmann three-mirror exam? The examinati... Read more
Reader Question:
No Definitive FBR Dx? Use Patient Complaint
Question: A 16-year-old boy presented with a scratchy sensation from a foreign body in his... Read more
Eye Exams:
92004 and 92014: Can You Code Comprehensive Exams Without Dilation?
You can bill for a second visit for a patient refusing dilation if you know these coding t... Read more
Compliance:
OIG to Send CMS Names of 1,700 Docs Who Overbilled High-Level E/M Codes
Frequency of reporting 99214 and 99215 increased 17 percent over 9-year period.If you exam... Read more
Billing:
Overcome Primary vs. Secondary Payer Woes With Answers to Your FAQs
Start with the basics and then move on to learning the intricacies.When a patient is cover... Read more
ICD-10 Delay:
Anticipate 1 Extra Year for Your ICD-10 Implementation Schedule
But don't count on the delay quite yet, expert warns.As part of a proposed rule to adopt a... Read more
Follow These CMS Rules for Submitting Medicare Secondary Payer Claims
Hint: Copy all beneficiary insurance cards, not just the Medicare one.When Part B practice... Read more
You Be the Expert:
Bilateral Pachymetry
Question: I'm trying to submit a claim for 76514 performed on both eyes, but I've been get... Read more
Reader Question:
224.8, 365.x Help Justify Gonioscopies With Photos
Question: Our optometrist saw a glaucoma patient and performed a gonioscopy. The optometri... Read more
Reader Question:
Base Billing Order on RVU Order
Question: I know that as a general rule the highest RVU has a higher billed amount and tha... Read more
Reader Question:
How Should You Bill Medicare?
Question: We are participating with Medicare. We bill and submit claims to Trailblazer (J4... Read more
Reader Question:
Insurers May Require Bundling Same-Day E/M Services
Question: Can we bill two office visits on the same day? We reported 99214 twice for ... Read more
Eye Allergies:
373.0, 375.15, or 372? Get Specifics on Eye Irritation to Find Best Dx Code
Scratch that spring allergy coding itch with this expert advice. Spring is here, which mea... Read more
Coding Errors:
One Medicaid Payer Reveals Its Top 5 Errors -- Know How You Can Avoid Making the Same Mistakes
Coding errors once again top the list of the most common mistakes.Did you catch a miscoded... Read more
Fee Schedule:
You Won't Face 27 Percent Medicare Cut for 2012
Congressional 10-month delay pushes payment formula problems to 2013.For practices fearing... Read more
Evaluate Your Billing Procedures With Internal Audits, Before an Outside Auditor Does
Starting with a baseline audit will set your practice up for success.Would you pass an aud... Read more
You Be the Expert:
Bilateral 76519, 92136
Question: The optometrist calculated IOL power in both a patient's eyes. Should I report t... Read more
Reader Question:
V58.69 Tells Part of Toxicity Follow-Up Story
Question: A primary care physician instructed one of our patients to see an eye doctor ann... Read more
Reader Question:
No Documented HPI Leads to No Coding for New Patient
Question: A new patient visits the optometrist with a chief complaint. I don't have a revi... Read more
Reader Question:
Double Check Copay Early to Save Time, Money
Question: A patient came to our office with the same insurance card she's had for years. W... Read more
Office Visits:
99201 or 92002? Don't Assume E/M and Eye Codes Are Interchangeable
Look to your documentation, and your local carrier's policies, to determine the best code ... Read more
Eye Code or E/M Code?
Consult this guide before picking a code for your next office visit.E/M Codes:New patient:... Read more
HIPAA:
With Audits Heating Up, Is Your Practice Ready?
Make sure your privacy and security practices are up to date.If your HIPAA protocols fall ... Read more
Build a Better Business:
Considering Going Out of Network? Follow These 3 Tips to Pave the Road to Success
Be honest with your patients to ensure a smooth transition.More and more providers are que... Read more
You Be the Expert:
Post-Op YAG Management
Question: We're having trouble filing for postoperative care for a YAG. How should we code... Read more
Reader Question:
92081-92083 x 1 Suffices for Many Pre-Bleph Exams
Question: Our doctor saw a patient for droopy eyelids, and to determine the extent to whic... Read more
Reader Question:
Does Ability to Bill the Patient Expire?
Question: Is there a time limit on when you can bill a patient for their balance due after... Read more
Reader Question:
Insurers May Require You to Bundle Same-Day E/M Services Together
Question: Can we bill two office visits on the same day? We reported 99214 twice for the s... Read more
Extended Ophthalmoscopy:
92225-92226 Claims Success Relies on Solid Documentation
Learn what distinguishes EO from the standard ophthalmoscopy included in most eye exams. W... Read more
ICD-10:
ICD-10 Date Will Be Postponed, HHS Confirms
Delay could offer practices additional time to prepare for new diagnosis coding system.Jus... Read more
Reimbursement Roundup:
Uncover Must-Know Appeals Changes Established By New Federal Law
Now's the time to find out how ERISA and PPACA impact your practice -- or you'll face... Read more
Compliance:
Figure Out Which 5010 Category Your Practice Falls Under
Watch out: Not everyone will have until March 31 to comply.You thought you wouldn't face e... Read more
You Be the Expert:
Ametropia
Question: Which ICD-9 code should I report for ametropia?Kansas SubscriberAnswer: The appr... Read more
Reader Question:
Append GY to Refraction Claims
Question: A doctor recently told me that appending modifier GY to the refraction code woul... Read more
Reader Question:
Pay Attention to Month, Not Year, With Birthday Rule
Question: I just received a call from a patient's parent claiming that we didn't follow th... Read more
Reader Question:
Prepare Wisely for Payer Fee Negotiations
Question: We're getting ready to begin contract renewal negotiations with one of our payer... Read more
Gonioscopy:
92020 Primer: Answer Bilateral, Dx Questions for Bulletproof Coding
3 answers to your frequently-asked gonioscopy questions.There may only be one gonioscopy c... Read more
ICD-10 Bridge
Once ICD-10 is implemented in 2013, the diagnosis codes in the above story will be differe... Read more
Medicare Errors:
Providers Underbilled More Than $1 Billion to Medicare in 2010
CERT results reveal $34.3 billion in improper Medicare payments -- $1.1 billion of wh... Read more
Documentation:
Make Audit-Proof Record Corrections With These 5 Tips
Documentation clarifications can be a big help -- if you use them wisely.With the ple... Read more
Workers' Compensation:
5 Guidelines Ease the Pain of Billing Workers' Compensation
If you don't get pertinent information before seeing the patient, expect trouble when you ... Read more
You Be the Expert:
Exam Without Dilation
Question: Can we bill for a comprehensive eye exam with 92004/92014 if the optometrist did... Read more
Reader Question:
92002 With V72.0 Is Fine With Most Carriers
Question: Our office has been coding exams (routine exams) as 92002 and V72.0 when we don'... Read more
Reader Question:
CMS Doesn't Currently Require Billing Certification
Question: I attended a conference recently and a speaker said that CMS is or will be requi... Read more
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