Coding News and Expert Advice

Coding News and Expert Advice
Empower your coding team with the up-to-date answers from the Academy's coding experts. Our carefully researched responses cover federal and commercial payers and help you improve documentation, submit clean claims and appropriately maximize reimbursement. Not a AAOE member? Join today.
Note: Coding regulations and edits can change several times a year. All Academy coding advice is based on most current information available at the time of publication. When in doubt, visit aao.org/coding for the most recent updates. Information provided by our coding experts is copyrighted by the American Academy of Ophthalmology and intended for individual practice use only.
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Coding Top 10 - November 2021

NOV 04, 2021 in Glaucoma, Cataract/Anterior Segment, Ask the Expert, Coding Updates, Exams, Pediatric/Strabismus, Coding Top 10, ICD-10

Get trusted answers to your coding questions from the Academy's coding experts, so you can bill and code with confidence.

Comments 0

Views 735

Billing when not the attending physician

NOV 04, 2021 in Exams, Ask the Expert

One of our physicians was called in to check a patient while she was in observation care. We are not the attending physician. How do we bill for this as an ophthalmologist?

Comments 0

Views 88

Billing exam with visual fields

NOV 04, 2021 in Ask the Expert, Exams, Glaucoma

A patient is a glaucoma suspect and has bilateral nuclear cataracts. The visual fields ordered and performed today are stable. Should this be billed at 99214 because there are two stable chronic diseases, and a visual field was ordered, and the results interpreted?

Comments 0

Views 193

Level of E/M documentation

NOV 04, 2021 in Exams, Glaucoma, Ask the Expert

A patient has stable primary open angle and nuclear cataracts, and the plan is to continue glaucoma meds and observe cataracts. What level of E/M does documentation support?

Comments 0

Views 139

Denials regarding certain ICD-10 codes

NOV 04, 2021 in Ask the Expert, Exams

I have been getting denials from payers regarding certain ICD-10 codes that cannot be billed together. Example: H16.223 Keratoconjunctivitis sicca, not specified as Sjogren’s bilateral and M35.01 Sjogrens’s syndrome.

Comments 0

Views 94

Billing based on exam time

NOV 04, 2021 in Ask the Expert, Cataract/Anterior Segment, Glaucoma

I have several patients with Parkinson's disease/diplopia. I'm trying different powers of Fresnel prisms to try to reduce their diplopia. The exams sometimes take over an hour. How can I bill these visits since the extended exam code, 99354, is no longer allowed? Can I bill…

Comments 0

Views 49

Billing with -53 modifer

NOV 04, 2021 in Ask the Expert, Glaucoma, Cataract/Anterior Segment

One of our surgeons performed a cataract surgery with a canaloplasty on the same day. The surgeon was not able to complete the canaloplasty due to the patient’s head tremors. She made multiple attempts but only about 30% of the canal was open and no further efforts were made…

Comments 0

Views 52

Code Removal of an Ahmed valve

NOV 04, 2021 in Glaucoma, Ask the Expert

How do we code the removal of an Ahmed valve?

Comments 0

Views 28

Appending modifier on bundled services

NOV 04, 2021 in Ask the Expert, Cataract/Anterior Segment

The patient had cataract surgery on the left eye (CPT code 66984 -LT) and a YAG laser capsulotomy on the right eye (CPT code 66821 -RT) on the same day. I know payment for the laser will be reduced by 50% as the second procedure, but do I need to append any modifier other th…

Comments 0

Views 73

Billing services for patient who is new to our practice but not to the physician

NOV 04, 2021 in Ask the Expert, Exams

The claims for one of our doctors who has been with our group for over a year keep getting denied when we bill for new patients. The patients were examined at the physician’s previous office, which has no connection to ours. How can we get paid for new patients at our office…

Comments 0

Views 51

Changes in CPT language for 99211

NOV 04, 2021 in Exams, Ask the Expert, Cataract/Anterior Segment

Has the CPT language for 99211 changed over the past few years?

Comments 0

Views 78

They’re Back: Target, Probe and Educate Requests for Records

OCT 20, 2021 in Regulatory News, Cataract/Anterior Segment

Target, Probe and Educate (TPE) is one of the many types of audits conducted by the Center for Medicaid and Medicare Services (CMS) requesting documentation.

Comments 0

Views 274

Cataract Documentation Checklist

OCT 13, 2021 in Regulatory News, Cataract/Anterior Segment

In this short video, Ravi Goel, MD presents a cataract surgery documentation checklist to prepare practices for Medicare's Target, Probe and Educate (TPE) audits.

Comments 0

Views 198

Where can I find the physician’s allowable for 83516 and 86891?

OCT 04, 2021 in Ask the Expert, Testing Services

Where can I find the physician’s allowable for 83516 and 86891?

Comments 0

Views 53

How do Medically Unlikely Edits (MUE) impact lab tests for dry eye disease?

OCT 04, 2021 in Ask the Expert, Testing Services

How do Medically Unlikely Edits (MUE) impact lab tests for dry eye disease?

Comments 0

Views 36

Of the published three category III codes, 0207T, 0330T and 0563T for treating MGD, are all billable per eye?

OCT 04, 2021 in Testing Services, Ask the Expert

Of the published three category III codes, 0207T, 0330T and 0563T for treating MGD, are all billable per eye?

Comments 0

Views 61

If the physician manually squeezes the patient’s lids, is there a separate CPT code to submit?

OCT 04, 2021 in Ask the Expert, Exams, Testing Services

If the physician manually squeezes the patient’s lids, is there a separate CPT code to submit.?

Comments 0

Views 56

When we perform any category III or miscellaneous code when diagnosing and/or treating MGD or DED, do we need a modifier on the exam performed the same day?

OCT 04, 2021 in Exams, Testing Services, Ask the Expert

When we perform any category III or miscellaneous code when diagnosing and/or treating MGD or DED, do we need a modifier on the exam performed the same day?

Comments 0

Views 16

Coding Top 10 - September 2021

SEP 22, 2021 in Retina, Oculofacial, Testing Services, ICD-10, Cataract/Anterior Segment, Exams, Glaucoma, Coding Top 10, Ask the Expert, Coding Updates

Get trusted answers to your coding questions from the Academy's coding experts, so you can bill and code with confidence.

Comments 0

Views 719

One of our doctors is stating that we can charge the patient for the optiwave refractive analysis (ORA) when the ultrasound, CPT code 92136 isn’t done. Is this true?

SEP 22, 2021 in Cataract/Anterior Segment, Ask the Expert, Testing Services

One of our doctors is stating that we can charge the patient for the optiwave refractive analysis (ORA) when the ultrasound, CPT code 92136 isn’t done. Is this true?

Comments 0

Views 89

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