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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CMS Releases Comparative Billing Reports on Cataract surgery

SEP 22, 2022 in Cataract/Anterior Segment, Ask the Expert, Coding Competency

Are you an outlier for cataract surgery and related services? Facilitated by the contractor RELI group, the Centers for Medicare & Medicaid Services has issued a comparative billing report (CBR) on Medicare Part B claims from Jan. 1 to Dec. 31, 2019 for three key metrics.

Comments 0

Views 28

Coding Top 10 - September 2022

SEP 20, 2022 in Pediatric/Strabismus, Ask the Expert, Oculofacial, Exams, Coding Top 10, Cataract/Anterior Segment, Retina, Testing Services, Trauma Coding, Coding Competency, 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 127

Possible Foreign Body Removal During Blepharoplasty Surgery

SEP 20, 2022 in Ask the Expert, Trauma Coding, Oculofacial

We had one of our surgeons perform an exploration of the medial upper lid for possible foreign body during a blepharoplasty procedure. There was no foreign body but excessive scar tissue. She debulked and biopsied the scar tissue and sent it to pathology.

Comments 0

Views 11

Different Specialty in the Same Office

SEP 20, 2022 in Ask the Expert, Exams, Coding Competency

We have a hearing aid specialist that performs hearing exams and provides hearing aids in our office. When the specialist sees patients, some may come back and see one of our physicians. Is this patient a new patient or an established patient to the other physician?

Comments 0

Views 22

Coding for Ruptured Capsule Repair

SEP 20, 2022 in Coding Competency, Cataract/Anterior Segment, Ask the Expert

During cataract surgery, the patient's capsule ruptured due to weak zonules. The IOL could not be implanted. Can you advise us of the code for this?

Comments 0

Views 20

Frequency Edits for Examinations

SEP 20, 2022 in Ask the Expert, Exams

Are there frequency edits for subsequent visits? Example: The patient has a corneal ulcer and comes back two days from the initial visit, and then three additional visits over a two-week period.

Comments 0

Views 28

ICD-10 Code for Old Retinal Tear

SEP 20, 2022 in Exams, Ask the Expert, Coding Competency, Retina

I’m curious to know what diagnosis code you would recommend for an old retinal tear (as opposed to an old RD)?

Comments 0

Views 19

Patching as Treatment Plan for Amblyopia and Level of Risk

SEP 20, 2022 in Pediatric/Strabismus, Ask the Expert, Coding Competency, Exams

What is the level of risk when patching is recommended for an amblyopia patient?

Comments 0

Views 4

Ophthalmic Biometry

SEP 20, 2022 in Coding Competency, Modifiers, Testing Services, Cataract/Anterior Segment, Ask the Expert

We filed 92136-TC and 92136-26 and identified which eye. I have filed several disputes, and those also have been denied. The payer told me the wrong modifier is being used.

Comments 0

Views 22

Single-Use Vial Used Bilaterally

SEP 20, 2022 in Coding Competency, Ask the Expert, Retina

Can a single-use vial be administered bilaterally to the same patient?

Comments 0

Views 7

CPT for Botox Injection

SEP 19, 2022 in Oculofacial, Coding Competency, Ask the Expert

What is the difference between using a 64612 vs. CPT 64615 for injection of Botox for blepharospasm?

Comments 0

Views 13

Is an Interpreter an ‘Independent Historian’

SEP 19, 2022 in Ask the Expert, Exams

Does using an interpreter or google translate allow you to choose higher-level evaluation and management (E/M) code for your office visit?

Comments 0

Views 8

How to Bill for MIGS

SEP 01, 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 25168

Interim Exam Between Cataract Surgeries

AUG 17, 2022 in Ask the Expert, Cataract/Anterior Segment

Can I bill for an interim exam between cataract surgeries?

Comments 0

Views 233

Coding Top 10 - August 2022

AUG 16, 2022 in Coding Top 10, ICD-10, Modifiers, Cataract/Anterior Segment, CPT, Retina, Pediatric/Strabismus, Telemedicine, Cornea, Testing Services, Trauma Coding, Exams, Coding Competency, Ask the Expert, 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 721

Placing KeraNatural Rings

AUG 15, 2022 in Cornea, Ask the Expert

What is advised for coding when placing the KeraNatural rings and arcs for keratoconus?

Comments 0

Views 34

Billing Diagnosis for Biopsies

AUG 15, 2022 in Oculofacial, Ask the Expert, Coding Competency

I often see eyelid lesions that I know are benign; however, I do not always know the precise name a pathologist would give the lesion. To be safe, I send it for confirmatory histopathology. What is the best practice here, do I have to bill it as a biopsy even when I know…

Comments 0

Views 80

Low Vision Exams

AUG 15, 2022 in Exams, Ask the Expert

We hired a new provider to do low vision exams. They often charge a level 5 E/M due to the amount of time spent with the patient. We are concerned because we rarely use this level for exams in our office. Is this appropriate for low vision exams?

Comments 0

Views 60

Correcting Ptosis Procedure

AUG 15, 2022 in Ask the Expert, Oculofacial, Pediatric/Strabismus

A patient had bilateral ptosis surgery at an ambulatory surgery center (CPT 67904 Mod: 50) During 90-day global period, the patient was seen in the office by the same surgeon, and it was determined that the right eye needed adjustment. Additional ptosis procedure was perform…

Comments 0

Views 50

Chemical Burn Seen and Admitted Same Day

AUG 15, 2022 in Trauma Coding, Pediatric/Strabismus, Ask the Expert, Coding Competency

Our provider took a 5-year-old patient to an outpatient facility to irrigate the eye following chemical burn. The child was put under anesthesia in the operating room (OR) and the eye was washed with saline. The patient was subsequently admitted for observation by the hospit…

Comments 0

Views 21

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