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Ophthalmology & Optometry Coding Alert

Vision Care Coding:
Adjust Your Focus and Sharpen Your Posterior Segment Imaging Claims
Use Medicare's LCDs as your viewfinder for fundus photos and EO payment. When you're putt... Read more
Put These 6 FP Limitations in Close Range View
To get fundus photography claims paid via Medicare, you've got to heed these requirements,... Read more
Ocular Ultrasound:
A or B or Both? Answer This Question to Select the Right Diagnostic Ultrasound Code
Lesion details and a spike graph are your clues. Submitting perfect claims for your physi... Read more
What Diagnoses Support 76510?
Drill down to assign the right condition with this refresher. Your physician will use dia... Read more
You Be the Coder:
Check Note Before Billing Pupillary Membrane Treatment
Question: One of our patients has pigmented pupillary membrane and has never had cataract ... Read more
Reader Question:
Don’t Code “Suspected” Abuse
Question: A patient presented at our office worried that she had a detached retina due to ... Read more
Reader Question:
Evaluate Therapeutic Contact Lens Replacement
Question: We have a patient with severe dry eye who needed replacement therapeutic contact... Read more
Proposed Codes May Change Your Cornea Diagnoses in October
Hereditary corneal dystrophies, corneal transplant complications might be coded differentl... Read more
Op Report Coding:
Translate These Common Acronyms to Decipher Op Reports
A few quick tips help you turn abbreviations into codes. Do you know your CRA from your I... Read more
Clip & Save:
Use This Guide to Define Eye-Focused Acronyms
We polled our experts and established a list of the most frequently documented abbreviatio... Read more
Patient Privacy:
Get A Handle on HIPAA Disclosure Laws
Can you bust these myths that involve the HIPAA Privacy Rule regulations? Most practices ... Read more
You Be the Coder:
What’s the Writeoff Policy With Secondary Payers?
Question: Thank you for your Q&A about patient writeoffs last month. I have a follow-u... Read more
Reader Question:
Any Physician Can Use Emergency Department Codes
Question: An emergency department (ED) physician asked our ophthalmologist to see a patien... Read more
Reader Question:
Evaluate Need for Eyelid Modifiers
Question: A Medicare patient presented with severe dry-eye syndrome. The ophthalmologist p... Read more
Reader Question:
Can Medical Assistants Select Codes?
Question: One of our ophthalmologists allows his medical assistant to choose his E/M codes... Read more
Evaluation Codes:
Check the Answers to These 3 E/M FAQs
Hint: It doesn't pay to play it safe. It's easy to focus your coding and billing efforts ... Read more
Your Signature Can Be Worth Thousands
Hint: Don't forget attestations when signatures are late. You pride yourself on the metic... Read more
Check This Primer on Timely Filing Rules
Hint: Track all claims to stay on track. Although most practices have become accustomed t... Read more
You Be the Coder:
Look to ‘G’ Code for Glaucoma Screening
Question: We can't find a code in CPT® for glaucoma screenings for Medicare patients. How... Read more
Reader Question:
Get the Scoop on 99211
Question: What are the rules regarding exactly when I can bill 99211 for a nurse visit? S... Read more
Reader Question:
Get the Scoop on Writeoffs
Question: We have had a few patients who don't pay their bills, even if we offer discounts... Read more
Reader Question:
Be Aware of the Unlisted Code Rules
Question: We reported 92499 for a service that had no CPT® code assigned to it but we are... Read more
Cataract Coding:
Can You Answer These Cataract Coding Questions?
Check this quiz to find out if you understand the cataract bundling rules. With complex c... Read more
E/M Coding:
4 Tips Help Curb Prolonged Service Coding Issues
Don't report another prolonged service until you read this. You're probably aware that th... Read more
Medicare Pay:
4 Tips for Smooth Consolidated Billing Practices
Seeing SNF patients can lead to payment hurdles if you don't know the rules. Almost every... Read more
Check This Sample Consolidated Billing Contract
Consolidated billing -- in which you bill the SNF directly for some services, and the SNF ... Read more
You Be the Coder:
Check This Modifier 59 Reminder
Question: Thanks for your article last month on the modifier 59 rules. The article said th... Read more
Reader Question:
CMS: New MBI Numbers Should Now Be the Norm
Question: How long do we have before we need to start reporting Medicare claims with ... Read more
Reader Question:
No One Answer to E/M Vs. Eye Code Question
Question: What criteria should eye care practices use when deciding between E/M codes and ... Read more
2019 Coding:
3 Tips Aid You in Reporting the 2019 CPT®, Diagnosis Codes
Hint: Evaluate laterality carefully when picking a diagnosis. Eye care practices have bee... Read more
Concurrent Care:
Account Carefully When Reporting Concurrent Care
Hint: Differentiate this service from duplicative care. Concurrent care scenarios are amo... Read more
CCI Edits:
CMS Clarifies Modifier 59 Usage Rules
Keep these tips in mind when deciding whether to separate edits. Some coders are so accus... Read more
Modifier 59 Isn’t Automatically the Best Choice
Although CMS has clarified its regulations for when you can report modifier 59 (... Read more
Perform Self-Audits Efficiently With These 3 Tips
Dig into your records and get the pulse of your practice's health As Medicare auditors st... Read more
You Be the Coder:
Bilateral Modifier Rules Can Get Confusing
Question:  Thank you for your article last month about bilateral coding. I have a fol... Read more
Reader Question:
Chief Complaint Must Venture Beyond Follow-up
Question: Our ophthalmologist lists the chief complaint for all follow-up visits using jus... Read more
CMS Pay:
Optometrists Logged Nation’s Highest DME Improper Payment Rate
Plus: Ophthalmologists suffered from upcoding errors. No one has ever said that coding fo... Read more
Get to Know CMS’ Evaluation Criteria
CMS identified a total of $31.6 billion in total improper payments among providers during ... Read more
Unilateral/Bilateral Coding:
Do You Know Which Diagnostic Tests Are Inherently Bilateral?
The difference could change how you code your claims. Eye care coding often hinges on whe... Read more
Check These Examples of Unilateral, Bilateral Eye Services
Before you report the bilateral modifiers on your claim, make sure you know whether your e... Read more
ICD-10 Coding:
Do You Have Signs and Symptoms Questions? We’ve Got Answers
Find out what to code – and what to leave off your claims. Reporting ICD-10 codes isn't... Read more
You Be the Coder:
Are You Prepared to Bill Incident to?
Question: We recently hired a nurse practitioner at our ophthalmology office and have... Read more
Reader Question:
Vet Your Employees – Avoid This Ophthalmologist’s Fate
Question: We are creating a new compliance policy, in which we'd like to include backgroun... Read more
Reader Question:
Get A Handle on New Vs. Established Patients
Question: We were recently audited and an established patient visit was marked as incorrec... Read more
Vision Care Coding:
MAC Rep: You Can Decide Whether to Report Refraction to Medicare
These and other questions were answered recently by one payer. Coding for eye care specia... Read more
2019 Payment:
Look Ahead to 2021 for Info on E/M Changes
Keep an eye on what may be coming up the pike. If your eye care staff members have been o... Read more
Looking Ahead:
Here's What to Expect in 2021
Although CMS won't be instituting big changes to E/M coding and documentation when the cal... Read more
Dry Eye Coding:
3 FAQs About Collecting for Schirmer's Testing
Hint: You won't find a code for the service in your manual. If you see patients with dry ... Read more
Reader Question:
Update Patient Records As New Cards Arrive
Question: We recently received a remittance advice and the number on it didn't match the n... Read more
Reader Question:
Go Beyond Diagnoses for YAG Laser Denial
Question: Our ophthalmologist used a YAG laser (66821) for a diagnosis of “vitreous stra... Read more
Reader Question:
Pinpoint SLT, ALT Codes
Question: If the physician performs SLT for glaucoma, which code should we report? What ab... Read more
You Be the Coder:
Watch Terminology With Consults
Question: Thank you for your article last month about consult coding. One of our main paye... Read more