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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How to Bill for MIGS

JUN 29, 2022 in Coding Updates, Glaucoma

Use of micro-invasive glaucoma surgeries continues to grow, as EyeNet explored in a recent cover story. However, none of the three main devices used in MIGS yet has a level 1 CPT code or established relative value units. Here's how to correctly code these surgeries.

Comments 0

Views 22703

Novitas Confirms J9035 Should Not Be Used to Bill for Intravitreal Injections of Avastin

JUN 21, 2022 in Coding Updates

In its latest revision to LCA (A53121) for anti-VEGF treatments applicable as of April 1, the Medicare administrative contractor Novitas added coding guidance language confirming once again that J9035 should not be used to bill for intravitreal injections. The correct code i…

Comments 0

Views 295

Noridian Reports Cataract Documentation Failure Rates

JUN 07, 2022 in Cataract/Anterior Segment, Coding Competency, Ask the Expert

Cataract surgery continues to be one of the most common surgeries performed, and because of this, remains a top audit target for all payers.

Comments 0

Views 820

Pop Quiz: Billing for New vs. Established Patients

MAY 31, 2022 in Ask the Expert, Coding Competency, Exams

Whether you are starting your own practice, joining a group practice, acquiring patients from another practice or opening a new office location across town, a practice transition will create situations in which it will be important to know if a patient is considered new or e…

Comments 0

Views 255

Coding Top 10 - June 2022

MAY 31, 2022 in CPT, Cataract/Anterior Segment, Coding Updates, Diabetes, Ask the Expert, Testing Services, Exams, Oculofacial, ICD-10, Retina, Glaucoma, Coding Top 10, Modifiers

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

Comments 0

Views 670

Mid-Year Forum 2022: Innovation in Ophthalmology and Its Impact on Coding, Coverage and Reimbursement

APR 26, 2022

Innovation in ophthalmology has always been central to our culture. While offering exciting opportunities for physician growth and patient care, innovation can affect coverage, patient access and reimbursement for physicians in complex ways, both directly and indirectly. The…

Comments 0

Views 214

Coding Top 10 - May 2022

APR 22, 2022 in ICD-10, Exams, Ask the Expert, Coding Updates, Glaucoma, Coding Competency, Retina, Coding Top 10, Modifiers, CPT, Cataract/Anterior Segment, Oculofacial

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

Comments 0

Views 1248

YAG Laser for Aqueous Misdirection

APR 22, 2022 in Ask the Expert, Glaucoma, Coding Top 10

Patient with aqueous misdirection that I performed a YAG to the anterior hyaloid face through the open capsule of the pseudophakic eye. I was going to code it just as YAG capsulotomy but that doesn’t seem right. What is the code for this procedure? I read several articles a…

Comments 0

Views 87

Comprehensive exam and Optos

APR 22, 2022 in Exams, Retina, Coding Top 10, Ask the Expert

Since it is not covered by insurance, can we bill the patient for Optos? Can we bill for a comprehensive examination when we use Optos even if we do not dilate the patient?

Comments 0

Views 231

Comanagement and Post-Operative Billing

APR 22, 2022 in Modifiers, Exams, Coding Top 10, Ask the Expert

Can we abstain from billing the days/visits that we see post-ops in order to not disrupt the referring and comanaging billing for the full 90 days? Or are we required to bill for the days that the patient is under our care?

Comments 0

Views 205

Eye Visit Codes for Inpatient Setting

APR 22, 2022 in Ask the Expert, Coding Top 10, Coding Competency, Exams

Can the Eye Visit codes only be used in the outpatient setting and not in the inpatient setting?

Comments 0

Views 105

Lesion Removal MUEs

APR 22, 2022 in Ask the Expert, Oculofacial, Modifiers, Coding Top 10

Patient had lesions removed on all four eyelids. MUE states it is three. Can we bill two separate line items each with a 50 modifier?

Comments 0

Views 98

New Light Adjustable IOL Coding and Billing

APR 22, 2022 in Cataract/Anterior Segment, Coding Top 10, Coding Competency, Ask the Expert

Can you offer any insight on the most appropriate way to bill the light adjustable IOL, RxSight? Would V2787 be an appropriate code since this seems to function most like a toric lens?

Comments 0

Views 138

Punctal Plug Supply Billing

APR 22, 2022 in Cornea, Coding Competency, Coding Top 10, Ask the Expert

Are we able to bill patients directly for the lacrimal plugs due to Medicare bundling them with the plug placement procedures?

Comments 0

Views 123

Ordered Tests and E/M Medical Decision-Making

APR 21, 2022 in Ask the Expert, Exams, Coding Top 10

If a provider orders an OCT to be performed before the patient’s next office visit could this be counted as ordering a unique test in the data category for medical decision-making even if the provider can bill for it when the patient comes in for the test?

Comments 0

Views 196

Outpatient Office Visit During Inpatient Stay

APR 21, 2022 in Exams, Coding Top 10, Coding Competency, Ask the Expert

We recently had a patient sent to us from our local hospital. We coded the office visit with E/M code 99204 and billed for fundus photos, CPT 92250. Both the office visit and the photos were denied by Medicare, which said the place of service is inconsistent with the procedu…

Comments 0

Views 92

Coding Top 10 - April 2022

MAR 31, 2022 in Coding Competency, Modifiers, Coding Updates, Glaucoma, Ask the Expert, Pediatric/Strabismus, Cataract/Anterior Segment, CPT, ICD-10, Exams, Oculofacial, Retina, Coding Top 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 497

92136 vs 76519

MAR 30, 2022 in Cataract/Anterior Segment, Coding Top 10, Ask the Expert

When we perform optical biometry, we occasionally do not get the axial length (AL) due to the cataract but can get the remaining measurements. We perform ultrasound/immersion only for the AL. Is it more appropriate to charge 92136 or 76519?

Comments 0

Views 115

Unified Program Integrity Contractor (UPIC) Audit

MAR 30, 2022 in Ask the Expert, Coding Competency, Coding Top 10

Could you advise me on how to move forward with a UPIC audit?

Comments 0

Views 102

Does This Support Modifier -59?

MAR 30, 2022 in Modifiers, Cataract/Anterior Segment, Ask the Expert, Coding Top 10

A physician performed complex cataract surgery 66982 OS on a patient and in the same session performed a 67005 OS. The op note reads: “One strand of vitreous was seen inferior-nasally so the anterior vitrectomy instrument was used to remove it.” Does this documentation sup…

Comments 0

Views 99

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