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Optometry Coding & Billing Alert

Testing:
Don't Let Unanswered IOL Power Calculation Questions Cloud Your Reimbursement
Read on for our expert answers to these 76519 and 92136 head-scratchers. Calculating i... Read more
Reimbursement:
Final Fee Schedule Confirms Phasing Out of Global Periods
Some practices should prepare for a 2 percent cut to Medicare payments. When CMS annou... Read more
Billing:
Step Up Your Benefits Verification for the New Year
Don’t leave eligibility checks to the last minute or you’ll face non-payment... Read more
ICD-10:
Keep Your Eye on Revised Retinal Detachment Diagnosis Codes
Substitute these H33.--- codes for the 361.xx ICD-9 codes. As with many of the diagnos... Read more
You Be the Expert:
Exophthalmometry
Question: Is there a CPT code for exophthalmometry? New York Subscriber Answ... Read more
Reader Question:
Try Modifier 52 for Unilateral OCT
Question: We performed an OCT on a patient’s left eye, and filed the claim wi... Read more
Reader Question:
Don't Bill Patient for Records Transfer
Question: Our practice discharged a patient due to non-payment, and one week later ... Read more
Extended Ophthalmoscopy:
Routine or Extended? Initial or Subsequent? Find Your EO Answers Here
Tip: Be sure to understand bilateral rules before you file your next claim.  For ... Read more
ICD-10:
Look to H10 Series for Conjunctivitis in 2015
Hint: In many cases, an additional digit will specify which eye is infected. When ICD-... Read more
Documentation:
New MAC Tip Reminds Practices What Ancillary Staff Can -- and Cannot -- Document
Documenting HPI is the job of the doctor or NPP. Your ancillary staff might be quite a... Read more
Billing:
Get Comfortable with Unruly Consolidated Billing Rules
Uncover who, what, and when to bill so you get your money. Knowing whether your skille... Read more
Correction
The answer to the “You Be the Expert” question in the Optometry Coding &... Read more
You Be the Expert:
Dry Eye Diagnosis
Question: Can 375.15 and 370.21 be used interchangeably? When would one be the pref... Read more
Reader Question:
Consider Including Telephone E/M in History or MDM
Question: We have a new patient that called his proivder to discuss his visit that ... Read more
Reader Question:
Determine POS Before Checking RVUs
Question: Using the RVUs provided for a particular code, how do I arrive at the app... Read more
DME Reimbursement:
Are These Refractive Lens Myths Keeping Payment Out of Your Pocket?
Tip: Keep modifiers KX, EY, GA in your toolbox. Optometrists across the country agree:... Read more
ICD-10:
Get to Know the New Senile Cataract Codes
In 2015, your diagnosis coding will specify condition as well as which eye is affected. ... Read more
Modifier Review:
Brace Yourself with Modifier 59 for Distinct Procedural Services
Refer to Medicare’s Correct Coding Initiative (CCI) before using Modifier 59 Mod... Read more
Patient Privacy:
Avoid Brutal HIPAA Fines With These 3 Steps
Take HITECH lessons to heart and protect your bottom line.  They might look like ... Read more
You Be the Expert:
Extended Ophthalmoscopy
Question: I just got a denial on 92226. I think I might be using this code incorrec... Read more
Reader Question:
Single Code's the Key for Multiple FBs
Question: How should I report the encounter when the optometrist removes a pair of ... Read more
Reader Question:
What's the Big ICD-10 Picture?
Question: I appreciate the monthly ICD-10 example in your newsletter, but I don&rsq... Read more
Coding Quiz:
Test Your VF Knowledge With These 92081-92083 Head-Scratchers
Then read on to see how your visual field coding and billing expertise stacks up. Visu... Read more
Compliance:
Watch Out For Sophisticated Malware Breaching Your Systems From Overseas
Pay attention: Massive breach teaches you four crucial lessons. The latest HIPAA breac... Read more
ICD-10:
Zero In on Specific Eyelid
The new set of diagnostic codes greatly expands on ICD-9’s “Other disorders ... Read more
Coding Quiz Answers:
Test Your Visual Field Knowledge
Hint: Unilateral or bilateral — it’s all the same to your payers. The ques... Read more
You Be the Expert:
Nonconclusive HRT
Question: How should I code for a nonconclusive HRT? One of our patients had one do... Read more
Reader Question:
Bring In ABN Benefits
Question: Should I bill Medicare for services that I know they’ll deny based ... Read more
Reader Question:
Appeal Is an Option When Patient Prevents Timely Filing
Question: We have a timely filing concern. Our physician saw a patient who didn&rsq... Read more
Contact Lenses:
5 FAQs to Sharpen Your Contact Lens Coding
Tip: It matters whether an optometrist or a technician provides the prescription and fit... Read more
ICD-10:
Know the New Dx Options for Diabetes With Ophthalmic Manifestations
In some cases, one code will do where you once needed two. The countdown is on: You no... Read more
ICD-10:
These 3 ICD-10 Answers May Surprise You
Hint: Forget everything you know about ICD-9’s ‘excludes’ codes after ... Read more
Chart Auditing:
Boost Your Confidence with Chart Sampling
Which of the three sampling methods will work best for your practice? You know that pe... Read more
You Be the Expert:
Low-Risk Glaucoma Screenings
Question: Our office sometimes performs glaucoma screenings for patients who don&rs... Read more
Reader Question:
Keep Modifier TC in Your 92081-92083 Toolbox
Question: We performed a visual field ordered by a doctor outside our practice. The pati... Read more
Reader Question:
Tackle UB-04 vs. CMS-1500 Dilemma
Question: I used to bill for a facility and am new to the role of practice manager ... Read more
Fundus Photos:
Check These Fundus FAQs to Keep Your Coding Straight
Do you know what to do if the optometrist only tests unilaterally? t’s a sign of... Read more
ICD-10:
Diagnostic Options Expand for Borderline Glaucoma
In 2015, your Dx code will have to specify which eye is affected. As you read elsewher... Read more
Modifiers:
CMS Debuts 4 New Modifiers to Substitute for 59
Medicare will still accept modifier 59, but use the new modifiers instead when applicabl... Read more
Documentation:
Avoid Faltering on Signature Rules & Exceptions With These 3
Useful Tips Analyze CMS’s requirements or you risk the wrong use of signatures. ... Read more
Reader questions:
Turn to Unlisted E/M If Visit Doesn't Match Key Element Requirements
Question: Can I use modifier 52 on 99201 if my provider only captures history and M... Read more
You Be the Expert:
Drug Effect Exam
Question: Which diagnosis code should I use to report visual field tests to evaluat... Read more
Gonioscopy:
Are These 92020 Myths Holding Back Your Reimbursement?
Get ready to learn the truth behind postoperative tests, bilateral billing, and more. ... Read more
ICD-10:
Report Glaucoma Type, Location, Stage All With 1 Code
In 2015, you’ll no longer need to report an additional Dx code to indicate glaucom... Read more
Part B Payment:
Proposed Fee Schedule Suggests Major Global Period Changes
Optometrists may see little impact, but other specialties’ reimbursement could ris... Read more
Modifier 25:
Major Payer Changes Modifier 25 Policy
You’ll need a new diagnosis for E/M payment from Tufts. Most optometry practices... Read more
News You Can Use:
See How CMS Addresses ICD-10 Delay
Users question ICD-9, too. You know that Congress instituted an ICD-10 delay, but do y... Read more
You Be the Expert:
Foreign Body Removal
Question: Can we code 65205 or 65220 if we used a cotton swab to remove a foreign b... Read more
Reader Question:
Use Caution With Write Offs
Question: At what point can we write off a patient balance as bad debt? Are there c... Read more
Reader Question:
Watch for Payer Differences With Claim Forms
Question: I need some help concerning the rules for billing on the new CMS-1500 for... Read more
Reader Question:
Don't Get Too Comfortable With Blanket ABNs
Question: I recently started working at a practice that I think overuses ABNs. Can we as... Read more
Reader Question:
Learn The Method to Determine Reimbursement Using RVUs
Question: Using the RVUs provided for a particular code, how do I arrive at the app... Read more
Coding Quiz:
Get Plugged In to Punctal Plug Reimbursement
Try your hand at the below questions, then read on for our expert answers. Between the... Read more
Coding Quiz Answers:
Shed No More Tears Over Punctal Plug Reimbursement
How do your answers compare with our experts’? Read on for the answers to the pu... Read more
ICD-10:
New Eye Irritation Diagnosis Codes Get Specific
Conjunctivitis, blepharitis and dry eye codes expand options starting October 2015. Wi... Read more
Compliance:
OIG Considers Expanding Civil Monetary Penalties
You could be subject to penalties for five additional reasons if the proposal is finaliz... Read more
News You Can Use:
CMS Answers ICD-10 Questions -- By Not Answering
Representatives stay mum about the details of the delay. The recent delay of ICD-10 un... Read more
HIPAA:
Let This Example Show You What Not to Do With Your BAs
Warning: You can be responsible for your BA’s violations. Your practice has a so... Read more
Reader Question:
Focus on 'Incident-to' Rules
Question: The following scenario occurred in our practice: Physician A covered an e... Read more
Reader Question:
Tackle UB-04 vs. CMS-1500 Dilemma
Question: I used to bill for a facility and am new to the role of practice manager ... Read more
You Be the Coder:
Non-Serial Tonometry
Question: Our optometrist renders single-episode tonometry services on her patients... Read more
FAQ:
Tackle These Exam-Without-Dilation Coding Scenarios
It’s a thorny coding dilemma, but savvy coders know the solution. A dilation is ... Read more
Advance Beneficiary Notices:
Know These 4 Categories of Noncovered Services
Sometimes it can be hard to determine what’s considered ‘noncovered.’ ... Read more
ICD-10:
Make the Most of the ICD-10 Extension With These Quick Tips
New implementation date is set for Oct. 1, 2015, so be ready. Whether you’re che... Read more
Payer Participation:
4 Tips Help You Successfully Collect for Services When Your Practice Does Not Participate
Hint: Collecting early is often the key. As payer contracts get more and more complica... Read more
Reader Question:
Assess Risk on a Regular Basis
Question: We are having a bit of a debate in our practice. Some of us think that pe... Read more
Reader Question:
Slow Patient Won't Justify Timely Filing Exception
Question: Our patient gave us her Medicare card but said Medicare was her secondary... Read more
You Be the Coder:
Long-Standing Strabismus
Question: Another ophthalmologist referred a new patient with long-standing strabis... Read more
CCI Update:
Watch for New Visual Function Screening Bundles
Tip: Check modifier indicators for ability to report codes separately. If your practic... Read more
News You Can Use:
Congress Votes to Halt Your Pay Cuts and Delay ICD-10
Physician associations still plan to pursue a permanent SGR formula revision.  Th... Read more
Documentation:
Adopt 7 Documentation Best Practices for Compliant and Complete Records
While the provider captures notes just once, they may be reviewed countless times. Whe... Read more
Modifiers:
Master Modifier 25 Following These Expert Tips
Haphazardly using 25 on all claims will lead to payer scrutiny. With payers cracking d... Read more
Reader Question:
368.8 Takes Secondary Place to Specific Diagnosis
Question: Many of our patients claim general reasons for their visit, such as &ldqu... Read more
Reader Question:
Consider a Flexible No-Show Policy
Question: During the snow storm last month, we had several patients call in and say... Read more
You Be the Coder:
FBR Follow-Up With Slit Lamp
Question: One of our optometrist uses a slit-lamp to check on healing after a forei... Read more
Diagnosis Coding Quiz:
Coding 250.00 for Patients With Ophthalmic Manifestations? Read This First
Test your knowledge of ophthalmic manifestations. With nearly 26 million Americans suf... Read more
ICD-10 Bridge
When ICD-10 comes into effect later this year, the ICD-9 codes in this article will no l... Read more
Diagnostic Tests:
Extended Ophthalmoscopy Claims Depend on Documentation, Proper Bilateral Billing
Tip: Don’t assume both eyes have the same diagnosis. Coding experts agree that e... Read more
ICD-10:
This Part B Payer Answers 10 Pressing ICD-10 Questions
Should you buy your book now or wait? These answers may guide you. As ICD-10 approache... Read more
ICD-10:
This Part B Payer Answers 10 Pressing ICD-10 Questions
Should you buy your book now or wait? These answers may guide you. As ICD-10 approache... Read more
Reader Question:
Incomplete Claims Equal Denials
Question: Our practice has a few claims that have missing or incorrect information.... Read more
You Be the Coder:
Unrelated Fundus Photos
Question: We have a patient still in the global postoperative period for cataract s... Read more
Extended Ophthalmoscopy:
4 Tips Help You Scope Out Clean 92225-92226 Claims
4 Tips Help You Scope Out Clean 92225-92226 Claims Remember: Documentation and proper ... Read more
Compliance:
Focus on 5 Areas for Improvement in Your Provider Documentation
While EMRs improve legibility, they may lead to other issues. When your practice faces... Read more
Part B Payment:
Congress Offers 3-Month Reprieve on Conversion Factor Cuts
Plus: Government moves toward possible SGR repeal. If you weren’t looking forwar... Read more
You Be the Expert:
Gonioscopies With Photos
Question: Our optometrist saw a glaucoma patient and performed a gonioscopy. The optomet... Read more
E/M Coding:
Follow The 3-Year Rule To Determine Patient Status
Hint: The place of service (POS) won’t influence your choice. The first step to ... Read more
Reader Question:
Append GY to Refraction Claims
Question: A doctor recently told me that appending modifier GY to the refraction code wo... Read more
Reader Question:
POS Determines Supply Reimbursement
Question: My doctors are concerned that our practice is losing money on supplies, such a... Read more
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