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Ophthalmology & Optometry Coding Alert

Visual Fields:
Don't Let These VF Myths Narrow Your Reimbursement Field
Are you regularly coding 92082 when you could justifiably code 92083? You’re not a... 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
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
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 adep... Read more
Reader Question:
Consider Including Telephone E/M in History or MDM
Question: We have a new patient that called his physician to discuss his visit that t... 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
You Be the Coder:
Slit-Lamp Photography
Question: I’m not sure when I can and can’t bill for slit-lamp photograph... Read more
Coding Quiz:
How Well Do You Know Coding for Laser Treatments for Diabetic Retinopathy
From focal laser to PRP, diagnosis codes and bilateral rules, there are a lot of variabl... 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:
New Blepharitis Codes Keep a Lid on Eyelid Conditions
In 2015, many diagnosis codes will specify which eye — and which lid. In an earl... Read more
Coding Quiz Answers:
Understand ICD-9, Bilateral Rules for Proper DR Coding
Tip: Code the diabetes first, then the manifestation. Does your DR coding knowledge st... 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
Reader Question:
Bring In ABN Benefits
Question: Should I bill Medicare for services that I know they’ll deny based ... Read more
You Be the Coder:
Blepharospasm Injection
Question: How would I report a Botox injection to control blepharospasm in only one... 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:
Zero In on Specific Eyelid
The new set of diagnostic codes greatly expands on ICD-9’s “Other disorders ... Read more
Modifiers:
Follow These Modifier 26 Dos and Don'ts to Keep Claims Flowing
Master your professional component claims with these quick tips. Modifiers 26 and TC g... 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
Reader Question:
Keep ABN Handy for Low-Risk Glaucoma Screenings
Question: Our office sometimes performs glaucoma screenings for patients who don&rs... 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:
Multiple FBs
Question: How should I report the encounter when the ophthalmologist removes a pair... Read more
CCI Update:
Watch for Amniotic Membrane, Implant Bundles
Note modifier indicators to see if separate reporting is possible. Amid the thousands of ... Read more
ICD-10:
Focus on New Diabetes With Ophthalmic Manifestations Dx Codes
In some cases, in 2015, one code will do where you once used two. The countdown is on:... Read more
Payment:
Look For Proposed CMS Global Period Overhaul
You could charge separate E/M, in many cases. A big surprise hit the presses in a rece... 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
ICD-10:
These 3 ICD-10 Answers May Surprise You
Hint: Forget everything you know about ICD-9’s ‘excludes’ codes after ... Read more
Reader Question:
Iris Hooks Help Make Complex Cataract Case
Question: Our ophthalmologist wants me to submit a claim for 66982, along with stre... Read more
Reader Question:
V-Codes Tell Drug Effect Exam Story
Question: Which diagnosis code should I use to report visual field tests to evaluat... 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
You Be the Coder:
Vitreous Strands
Question: Our ophthalmologist has performed a YAG laser for a diagnosis of “v... Read more
IOLs:
Coding for AC/PC IOLs? Read This First
You’ve got a little more work to do if your cataract patient wants more than the t... Read more
ICD-10:
Look to H26.0-- Codes for Nonsenile Cataracts
Use sixth character to specify which eye is affected. In a previous issue, we looked a... Read more
CCI Update:
Beware Hospital Outpatient Clinic Bundles
G0463 edits affect more than 5,000 codes. Sometimes you’ll see a lull in new Cor... 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. If you are n... Read more
Reader Question:
No Needle Needed for 65205, 65220
Question: Can we code 65205 or 65220 if we used a cotton swab to remove a foreign b... 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:
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
Reader Question:
Don't Get Too Comfortable With Blanket ABNs
Question: I recently started working at a practice that I think overuses ABNs. Can ... Read more
You Be the Coder:
Cataract Surgery With Vitrectomy
Question: My provider that I work for wanted me to bill 66982, 67010-51 out, but ac... Read more
Cataracts:
Simple Solutions for Complex Cataract Coding
Our expert answers for your frequently-asked 66982 questions. With cataracts affecting... 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
Compliance:
OIG Considers Expanding Civil Monetary Penalties
You could be subject to penalties for five additional reasons if the proposal is finaliz... 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:
Include Non-Serial Tonometry in Exam
Question: Our ophthalmologist renders single-episode tonometry services on her pati... 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
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
You Be the Coder:
Bilateral Eyelid Procedures
Question: Should I append modifier 50 to 67820 for a bilateral procedure? Georgia... Read more
Diagnostics:
Fundus Photography Coding Story Doesn't End at 92250
Incorrect coding could cost your practice $79 each time. If your practice is like most... 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 in the a... 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
Advance Beneficiary Notices:
Know These 4 Categories of Noncovered Services
Sometimes it can be hard to determine what’s considered ‘noncovered.’ ... Read more
Reader Question:
67331 Describes Previous Non-Strabismus Surgery
Question: When should I use CPT® code 67331? I have been told in the past that ... Read more
Reader Question:
Use J7316 for Jetrea
Question: My ophthalmologist has started using Jetrea to treat VMA. How should we c... Read more
You Be the Coder:
H&P With Eye Exam
Question: We have a new doc in the office who is performing her own history and phy... Read more
Coding Quiz:
Can You Untangle These Bleph Repair Scenarios?
Try your hand at coding these procedures, and then compare your answers with our experts... Read more
Coding Quiz Answers:
Check Your Bleph Repair Savvy Here
How did you do with our 6 surgical scenarios? Were you able to select the appropriate ... 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
Reimbursement:
24 Percent Medicare Pay Cut Averted
Expect level pay through March 31, 2015. You’re probably used to this by now sin... Read more
Reader Question:
Long-Standing Strabismus
Question: Another ophthalmologist referred a new patient with long-standing strabis... Read more
Reader Question:
Incomplete Claims Equal Nonexistent Payment
Question: Our practice has a few claims that have missing or incorrect information.... Read more
Reader Question:
Consider a Flexible No-Show Policy
Question: During the snow storm earlier this year, we had several patients call in ... Read more
You Be the Coder:
Ametropia Diagnosis
Question: Which ICD-9 code should I report for ametropia? Kansas Subscriber ... Read more
CCI Update:
Watch for New Injection, Visual Function Screening Bundles
Tip: Check modifier indicators for ability to report codes separately. If you’re... Read more
ICD-10-CM:
Prepare for More Specificity in Strabismus Coding
New diagnosis codes specify which eye is affected. When ICD-10 becomes effective, you&... 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:
Only Report One 66821 Performed on Same Eye During Global
Question: The doctor performed a YAG laser capsulotomy. Six months later, during a ... Read more
Reader Question:
Supply Reimbursement Depends on POS
Question: My doctors are concerned that our practice is losing money on supplies, s... Read more
Reader Question:
Unbundle 67904 and 15823 Under These Clinical Circumstances
Question: Our oculoplastic surgeon performed levator resection and blepharoplasty o... Read more
You Be the Coder:
Excision After Incision
Question: The ophthalmologist incised a patient’s conjunctival cyst (68020). ... Read more
Diagnosis Coding:
Fifth Digit Makes the Difference When Coding Ophthalmic Manifestations of Diabetes
Don’t default to 250.00 — follow these three crucial tips to find the right ... 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
Reader Question:
Test Your ICD-10 Coding in March
Question: I have heard that there will be a test period for using ICD-10 codes on c... Read more
You Be the Coder:
IOL Exchange
Question: What code should I use to report when the ophthalmologist replaces an int... Read more
CCI 20.0:
Watch for New 66183 Bundles
Hundreds of procedures are now included with the new code for insertion of an aqueous dr... Read more
FBRs:
3 Myths Can Get Stuck in Your 65205-65222 Claims
Are you cheating your practice out of deserved reimbursement? Are you routinely select... Read more
ICD-10 Bridge
Once ICD-10 is implemented in 2013, the diagnosis codes in the above story will be diffe... 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
Reader Question:
Opt for First-Initial, Last-Name Privacy Protocol
Question: What guidelines should our group follow to protect the privacy of patient info... Read more
You Be the Coder:
Secondary IOL Implant
Question: A patient is going to have a secondary IOL implant. Is 66985 the right code? W... Read more
Retinal Surgery:
Coding Recurrent Repairs? Use These Tips to Choose Between 67108 and 67112
Forget initial-vs.-subsequent rules for thumb for 67108 and 67112. Two retinal repair ... Read more
CPT® 2014:
99446-99449: New E/M Codes Capture Doc Discussions
Make sure to include a written report. Who knows if Medicare will pay, but you should ... Read more
Medical Necessity:
Keep an Eye on Guidelines for Ophthalmic Diagnosis Coding
You’re not quite done with ICD-9 yet, so follow these tips for more claims success... Read more
E/M:
Navigate the New-Versus-Established-Patient Maze With Expert Tips
Different locations, same physician? Use established patient codes. When reporting man... Read more
Reader Question:
ICD-10 Countdown Prep
Question: Do you have any advice about what our surgical practice can be doing to prepar... Read more
Reader Question:
Know How to Email Without Violating HIPAA
Question: I sometimes e-mail patient records to consultants for help on how to bill. How... Read more
You Be the Coder:
EOM Function Test
Question: My ophthalmologist wants to code for a “detailed evaluation of EOM funct... Read more