Don't have a TCI SuperCoder account yet? Become a Member >>

Ophthalmology & Optometry Coding Alert

Surgical Coding:
3 FAQs Help Guide Your Oculoplastic Coding
Remember: Not all plastic surgeries are considered cosmetic. If you've spent any time in ... Read more
Can You Code These Cataract Diagnosis Examples?
It's likely that your practice codes cataract diagnoses on a daily basis, and often you're... Read more
E/M Coding:
Performing A Consult? Get the Facts
Some visits are consults in name only. It happens from time to time – a patient calls r... Read more
Reader Question:
Get to Know the E/M Time Coding Guidelines
Question: Our ophthalmologist spent 40 minutes face-to-face with a patient and documented ... Read more
Reader Question:
Check This Workers' Comp Advice
Question: We had a patient come in who had an eye injury he had incurred at work, but the ... Read more
Reader Question:
CPT®, ICD-10 Codes Will Depart LCDs
Question: We recently learned that CMS is instructing the MACs to change the local coverag... Read more
Reader Question:
Insurance Info Doesn't Come Through? Here's What to Do
Question: We recently saw a Medicaid patient, but at the time of service he did not provid... Read more
You Be the Coder:
Should Facility Code Match Surgeon's?
Question:  I code for a surgery center and an associated physician clinic. Most of ou... Read more
CPT® 2019:
Look for New ERG Codes Effective Jan. 1
Plus: Several Cat. III codes will debut for eye care practices. Feeling like your CPT® b... Read more
3 Facts and 1 Myth About Modifier 24
Hint: Knowledge about the global surgical package is imperative. It happens from time to ... Read more
HIPAA Breaches Skyrocketed This Summer
Make sure you aren't next. As summer ends and the season turns to fall, a look back at th... Read more
Reader Question:
No Signature? No Payment
Question: We submitted our records to our MAC following a payer request, and for one physi... Read more
Reader Question:
Be Strategic – And Safe – When Entering Social Media
Question: We attended a presentation by a health care marketing organization who said we s... Read more
Reader Question:
Thinking About Coding Based on Dx? Think Again
Question: Which code should we report for evaluation of diabetic retinopathy and glaucoma?... Read more
You Be the Coder:
How Can You Report Sedation in the ASC?
Question:  Our ophthalmologist performed a cataract discission with sedation. We're r... Read more
Are You Confusing Medical Necessity With Medical Decision-Making?
Eye care practices that make this error could see an uptick in claim denials. You've hear... Read more
Look to "B" Code Series for Herpes Viral Ocular Disease
Even shingles can affect the eyes – know how to code this condition. If you've never se... Read more
When Your Physician Leaves Town, Know These Reciprocity Rules
Hint: Locum tenens and reciprocal billing are not the same. Whether the eye care physicia... Read more
Reader Question:
Is Pay for Level One E/M Codes Changing?
Question: Thank you for your comprehensive review of the new proposed payment rates for 20... Read more
Reader Question:
New Rules Will Impact Advanced Practice Providers
Question: We received a memo from our Part B Mac, NGS Medicare, about new rules for nurse ... Read more
Reader Question:
Take Care When Discarding Electronic Devices
Question: One of the doctors at our practice got a new cell phone and gave his old phone t... Read more
You Be the Coder:
How Would You Report Chip Removal During Cataract Excision?
Question:  Which CPT® code do I use for the removal of a nuclear eye chip from the p... Read more
Part B Payment:
CMS Aims to Make Big Changes to E/M Coding — Would Your Eye Care Practice Be Impacted?
One ophthalmologist in our sampling would lose $39,000 a year under the new proposal. Alt... Read more
Check Out These Examples of How Optometrists Would Fare
You saw how three ophthalmologists would fare under the proposed E/M payment changes —no... Read more
Part B Payment:
Check out The Proposed 2019 Conversion Factor
And get to know these other potential changes on deck for 2019. The proposed E/M changes ... Read more
Ease Patient Stress With Answers to These EOB FAQs
Helping patients understand their EOBs can be a great step toward positive patient relatio... Read more
Use Data in Remittance Advice to Boost Bottom Line
Here's how to extract what you need from the RA. You may not be accustomed to scrutinizin... Read more
Reader Question:
Get A Handle on When Codes Become Invalid
Question: We recently learned that if the procedure code was invalid on the date of servic... Read more
Reader Question:
Modifier 50 Doesn't Apply in Every Case
Question: We reported 92134-50 and we only received unilateral payment. Should we have rep... Read more
You Be the Coder:
Get the Scoop on Free Sample Rules
Question: Our eye care physicians frequently hand out free samples to patients – usually... Read more
New Blepharitis, Eyelid Cancer Codes to Debut Oct. 1
No other specialty has as many new codes as ophthalmology this year. If you've become acc... Read more
Check These Additional New Diagnosis Codes
Brow ptosis, clonic facial spasm get additional specificity effective Oct. 1. The ICD-10 ... Read more
Patient Privacy:
Guard Your Practice Against PHI Theft With These Tips
Make HIPAA security a priority to secure patient data. You've put passwords on your compu... Read more
Reader Question:
Get the Scoop on Reopening
Question: Thanks for your article on appeals last month – we are currently creating an a... Read more
Reader Question:
Medicare Advantage Claims Under Scrutiny
Question: We've been seeing an increase in denials for Medicare Advantage lately. Has some... Read more
Reader Question:
Differentiate Glaucoma Screening Codes
Question: We perform frequent glaucoma screenings on high-risk patients and it seems like ... Read more
You Be the Coder:
Lens Opacity May Not Warrant Cataract Excision
Question: We had a patient present because her son told her that her eyes are “cloudy.... Read more
3 Recent Cases Reveal Eye Care Fraud Vulnerabilities
Want to avoid these issues? Keep an eye on your compliance plan. As healthcare auditors i... Read more
Expert Offers 4 Essentials for Successful Appeals
Hint: Try and open communication lines with payers. “Time is money,” the old saying g... Read more
Participating With Advanced APMs? Consider These Facts First
Programs have pros and cons—and you should be aware of both. Most Part B practices have... Read more
Reader Question:
Could the Stark Law Affect Your Practice's Plans?
Question: Several ophthalmologists from our practice want to open an outpatient clinic tog... Read more
Reader Question:
Medicare Claims Require Keen Understanding of Calendar
Question: We had a problem with a claim and didn't get it filed with Medicare until over a... Read more
Reader Question:
Avoid Reporting 66180, 67255 Together
Question: We are confused about whether we can report 66180 (Aqueous shunt to extraoc... Read more
You Be the Coder:
Get to Know Refraction ABN Rules
Question: Thank you for your article last month about explaining payers' refraction polici... Read more
Explain Refraction Billing Issues to Patients With These Tips
Tip: Create a refraction policy to smooth the conversation. Every eye care practice has e... Read more
Clip And Save:
Use This Sample Refraction Policy to Help Create Yours
If you're considering creating a refraction policy at your practice, customize the followi... Read more
Recent Medicare Audit Shows Eye Care Practices' Opioid Prescribing Habits
Optometrists scored higher than average in one category, results show. Eye care physician... Read more
Nail Down the Right ICD-10 Codes for These Cornea Diagnoses
Can you select the appropriate diagnosis after reading the case? Treating cornea diagnose... Read more
Reader Question:
Do We Code Diagnoses Based on History?
Question: A patient presented to the office for an exam and the ophthalmologist diagnosed ... Read more
Reader Question:
Could You Be Exceeding Frequency Guidelines?
Question: We saw a 15-year-old patient bimonthly last year for orthoptic training and we r... Read more
Reader Question:
How to Prevent Mobile Device Issues
Question: Our staff members now carry tablets where they record their documentation. Twice... Read more
Reader Question:
Who Can Report Glaucoma Screening?
Question: We've been performing glaucoma screenings on Medicare patients at our office, bu... Read more
You Be the Coder:
Know the Rules for Multiple Ocular EMGs
Question: Our physician performed needle oculoelectromyography bilaterally and we reported... Read more
Cataract Surgery:
Auditors Launch New Cataract Claim Reviews
Hint: New audits will look back at claims for the past three years. Most eye care practic... Read more
Retina Coding FAQs:
Can You Select the Right ICD-10 Codes for These Retinal Conditions?
Choose the appropriate diagnosis after reading the case. Although most eye care practices... Read more
Make Medicare Secondary Payer Claims A Breeze With A Few Simple Tips
This Part B rep leads the way to the best MSP practices. Patients often present with mult... Read more
This Chart Can Help You Pinpoint Primary Payer
You're likely to encounter multiple situations that you may see when you have to determine... Read more
Reader Question:
Differentiate Modifiers 59, 79
Question: A patient with commercial insurance underwent a YAG capsulotomy on the left eye ... Read more
Reader Question:
Is Time on Your Side?
Question: We saw a patient who hadn't been to an eye care specialist for over a decade and... Read more
Reader Question:
Devil Is in The Details for Eye Surgeries
Question: The physician performed pterygium excision and we reported 65426 (Excision or tr... Read more
Reader Question:
Are Modifier 24 and 25 Compatible?
Question: Can you ever report modifiers 24 and 25 on the same claim? Subsc... Read more
You Be the Coder:
How Can You Determine When Blepharoplasty Is Cosmetic?
Question: We performed blepharoplasty for a patient who was left with a drooping eyelid fo... Read more
Know These 5 Facts About Fundus Photography Coding
Hint: Watch your diagnosis codes every time you report 92250. Fundus photography is one o... Read more
Avoid This Ophthalmologist's Fate — Know How to Spot Inducements
Hint: Internal audits can help you avoid kickback allegations. Health care auditors are i... Read more
ICD-10 Coding Quiz:
Can You Answer These Eye-Related Diagnosis Coding Questions?
Evaluate your ICD-10 knowledge with this quick quiz. You may find it challenging to selec... Read more
ICD-10 Coding Quiz Answers:
Check Out How You Fared in Our Diagnosis Coding Quiz
How did you fare in our ICD-10 on the coding quiz? Read on for the solutions to these diag... Read more
E/M Coding:
3 FAQs – And Answers – About Inpatient E/M Coding
Most ophthalmologists use the outpatient E/M codes far more often than they bill hospital ... Read more
Reader Question:
Heed This Documentation Shift
Question: Our ophthalmologists complain about having to re-document the elements of E/M se... Read more
Reader Question:
Look to H44.3 Section for Chalcosis
Question: Our ophthalmologist saw a patient in the hospital who had been admitted by a gas... Read more
Reader Question:
Modifier Q6 Is Your Key to Locum Tenens Pay
Question: We have never submitted a claim for a locum tenens (LT) physician, but we recent... Read more
You Be the Coder:
Should You Avoid 92002 for Refraction?
Question: When we perform refraction, should we use an E/M code like 99212 or an ophthalmo... Read more
Part B Errors:
CMS: Ophthalmologists Among Specialties With Highest Error Rates for Office Visits
Don't make the same mistakes these practices did. Ophthalmologists frequently struggle wi... Read more
ICD-10 Coding:
Can You Accurately Diagnose These 3 Infrequently-Seen Eye Conditions?
Put the codes for coloboma, Behcet's Disease and more into your toolkit. You may know the... Read more
Recovery Audit Contractors:
This RAC Is Scrutinizing E/M Codes Billed With Procedures
Be completely sure modifiers 24, 25, and 57 are right for you before you employ them. Eve... Read more
Reader Question:
Code Definitive Dx, When Known
Question: Often, the physician will list several symptoms and signs that the patient is ex... Read more
Reader Question:
Mind These ROS Documentation Tips
Question: What is the best way to document review of systems (ROS)? We know ancillary staf... Read more
Reader Question:
State Law Dictates Patient Dismissal Rules
Question: We have a patient who is frequently verbally abusive to our staff members. It's ... Read more
You Be the Coder:
CMS: Don't Text Physician Orders
Question: Our physician recently texted an order for an x-ray of the orbit and the radiolo... Read more
3 Quick Tips Help Eye Care Practices Improve Clinical Documentation
By working with clinicians, you can decrease the burden on all staff members. As eye care... Read more
Practice Management:
Managing Clinical Flow? Consider These Tips
Hint: It could come down to scheduling and staffing. When it comes to improving clinical ... Read more
Patient Privacy:
Bring Old School HIPAA Rules Into the New Year With These Tips
Most likely, some staffers have completely forgotten the tenets of HIPAA. The potential w... Read more
Reader Question:
Differentiate Viral Pinkeye From Allergic
Question: We saw a patient with pinkeye related to a specific virus, and we've never seen ... Read more
Reader Question:
Are You Hip to HPI?
Question: One area where our physicians don't document well enough is history of present i... Read more
Reader Question:
HIPAA Rules Still Apply When Patients Pass Away
Question: How long do I need to maintain a patient's private health information after that... Read more
Reader Question:
RACs Are Looking at This E/M Issue Now
Question: We haven't been keeping up with what the recovery audit contractors (RACs) are r... Read more
Reader Question:
Medicare Covers Some Glaucoma Screenings for Asymptomatic Patients
Question: Our office manager thinks we can only perform glaucoma services on patients who ... Read more
You Be the Coder:
How Should You Report Multiple Eyelash Removals?
Question: We saw a patient with several eyelashes growing in toward her eyes, so the physi... Read more
Practice Management:
Streamline Office Flow by Evaluating How Many Patients Your Docs Can Realistically See
Once you know the "true" schedule, you can create a system that keeps patients flowing thr... Read more
High-Profile Ophthalmologist Could Get 30 Years in Prison for Medicare Fraud
Avoid his mistakes to ensure you don't get caught in the government's crosshairs. Overbil... Read more
Part B Claims:
10 Mistakes to Avoid When Submitting Your Medicare Claims
Follow these tips, straight from the Medicare reps, to get your claims paid quickly. If y... Read more
Reader Question:
Know When Modifiers TC, 26 Apply
Question: How should we code for a visual field test ordered by a doctor outside the pract... Read more
Reader Question:
Beware of EHRs That Auto-Populate
Question: I am the new office manager at an eye care practice that uses EHRs that have tem... Read more
Reader Question:
When Does ICD-10 PCS Apply?
Question: Should we be capturing ICD-10-PCS codes in our eye care practice? We currently u... Read more
Reader Question:
Doctors, Coders Can Work Together With These Tips
Question: I have a doctor that wants to see in writing where she has to document anywhere ... Read more
Reader Question:
Prep System for New Medicare Numbers Next Year
Question: We have a lot of patients asking about the new Medicare cards, but no one has th... Read more
Reader Question:
Know When You Can Report Modifiers 24, 25 Together
Question: Can we ever report modifiers 24 and 25 on the same claim? Subscr... Read more
You Be the Coder:
Know When EO Is Separately Reportable
Question: Is extended ophthalmoscopy (EO) included in a general ophthalmic examination or ... Read more