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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Back to the Basics: Testing Services, Part 1

AUG 04, 2021 in Coding Updates, Testing Services

From A-scans to visual fields, ophthalmologists perform and order a lot of tests. High volume of any test also results in third-party payer audits. Best practices research each payer’s requirements for documentation beginning with high volume tests, so when that inevitable r…

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Coding Top 10: Unbundling 92250 with 92133 or 92134, Denials for testing services with code N433, Determining the correct modifier

JUL 22, 2021 in ICD-10, Ask the Expert, Coding Top 10, 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 545

Determining the correct modifier

JUL 21, 2021 in Modifiers, Ask the Expert

We need help determining the correct modifier to use on a claim.

Comments 0

Views 122

Commercial payer denying claims for Avastin

JUL 21, 2021 in Ask the Expert

We are having issues with a commercial payer denying claims for Avastin? They are denying these claims stating that the National Drug Code (NDC) number should be 11 digits not 10. Any information is helpful.

Comments 0

Views 64

Billing when Avastin is performed bilaterally

JUL 21, 2021 in Ask the Expert

One of the providers asked if Avastin could be performed bilaterally. The billing department gave the okay. The code 67028 has medically unlikely edit (MUE ) of 1 and Medicare Physician Fee Schedule (MPFS) indicator of 1 while J7999 has MUE of 2 and MPFS indicator of 9.

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Views 63

We injected a patient with clindaymcin. When I searched, all I found was an S code. Can you confirm this is true?

JUL 21, 2021 in Ask the Expert

We injected a patient with clindaymcin. When I searched, all I found was an S code. Can you confirm this is true?

Comments 0

Views 35

Denials for testing services with code N433

JUL 21, 2021 in Testing Services, Ask the Expert

We are getting a lot of denials for testing services with code N433. We are wondering what we are doing wrong to get this denial code.

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Views 51

Is a Schirmer’s test is billable?

JUL 21, 2021 in Testing Services, Ask the Expert

Can you tell me if a Schirmer’s test is billable?

Comments 0

Views 44

Palmetto, our Medicare administrative contractor (MAC) is denying ICD-10 code H53.40

JUL 21, 2021 in Testing Services, Ask the Expert

Palmetto, our Medicare administrative contractor (MAC) is denying ICD-10 code H53.40 Unspecified visual field defects for CPT code 92133 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic ner…

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Views 49

If visual fields and retinal nerve fiber layer OCTs are performed on the same day, are they covered by insurance?

JUL 21, 2021 in Ask the Expert, Testing Services

Is there any website or person that I can contact to find out if visual fields and retinal nerve fiber layer (RNFL ) OCTs are covered by insurance if performed on the same day? I have been told many different things regarding this and want to find out what is accurate.

Comments 0

Views 58

Billing ultrasound same day as cataract surgery

JUL 21, 2021 in Ask the Expert, Testing Services

One of my doctors had to do cataract surgery on a severe mentally ill person but had to do the ultrasound same day while the patient was under anesthesia. What code and modifier should I use, and can I charge the ultrasound at all?

Comments 0

Views 43

Unbundling 92250 with 92133 or 92133

JUL 21, 2021 in Testing Services, Glaucoma, Retina, Ask the Expert

Our practice received an audit request for 10 records. They are all times when we’ve unbundled CPT code 92133 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve or 92134 retina from 922…

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Views 116

Effective July 11, First Coast Service Options and Novitas Solutions Update Cataract Local Coverage Determination (LCD) Policies

JUL 09, 2021 in Cataract/Anterior Segment, Coding Updates

Effective July 11, First Coast Service Options and Novitas Solutions Update Cataract Local Coverage Determination (LCD) Policies

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Views 317

Two new Category III codes impacting glaucoma surgeons effective July 1, 2021.

JUL 06, 2021 in Coding Updates, Glaucoma

Two new codes impacting glaucoma surgeons effective July 1, 2021.

Comments 0

Views 311

Submit Claim with Sample Drug

JUN 17, 2021 in Ask the Expert

When billing injections, is the HCPCS drug code necessary even when no payment from the payer is required?

Comments 0

Views 164

Coding Top 10: Payment for Intra-operative Injection , Practice Telemedicine Protocol, Billing Consultation Codes When Medicare is Secondary

MAY 13, 2021 in Coding Top 10, ICD-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 566

CAAP Recoupment on Medicare Claims

MAY 13, 2021 in Regulatory News

Ophthalmic practices who received a COVID Accelerated/Advance Payments (CAAP) from CMS will start to see a new physician adjustment amount on their remittance advice.

Comments 0

Views 251

Documentation Rules for Physicians and Non-Physician Practitioners

MAY 13, 2021 in Exams, Ask the Expert

I’ve read that an ophthalmologist does not have to redocument information in the chart note, but does that also apply to our physician assistant (PA)?

Comments 0

Views 120

External Surgeon Using Laser

MAY 13, 2021 in Ask the Expert, Glaucoma

A physician outside of our practice asked to use our laser to perform selective laser trabeculoplasty (SLT) on her patients. Although we have reached out to our malpractice carrier for potential concerns, are there billing issues that need addressed?

Comments 0

Views 41

Billing Corneal Hysteresis More Than Once

MAY 13, 2021 in Glaucoma, Ask the Expert, Testing Services

Can corneal hysteresis be billed again after an intervention such as an SLT or starting new medication?

Comments 0

Views 41

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