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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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 94

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 885

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 75

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 158

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 124

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 77

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 69

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 65

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 85

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 131

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 59

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 372

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 59

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 51

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 57

Interpretation and Report

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

Do I have to create a separate interpretation for OCT-RNFL or may I state “see OCT” in my plan?

Comments 0

Views 63

XEN-EX: External Approach

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

Our vendor and Xen Gel state the billing code for the stent is 0449T but that is for an internal approach to the surgery, whereas my doctor uses an external approach. Would code 66183 be appropriate to use for the external approach?

Comments 0

Views 43

Is It Appropriate to Append Modifier -77 to a Diagnostic Test?

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

Optical coherence tomography (OCT) was performed by an ophthalmologist, who then referred the patient to a retina specialist. The retina specialist performed and interpreted an OCT as well. Can we append modifier -77 in this scenario?

Comments 0

Views 13

Unilateral Contact Lens Fit

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

CPT 92072 (fitting of contact lens for keratoconus) has a bilateral surgery indicator of “2” in Medicare’s database. Is it correct not to use modifier -50 and if one eye is fitted, use modifier -52?

Comments 0

Views 22

Unable to Properly Fit Prokera

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

A cornea specialist asks if it is appropriate to bill for Prokera placement (65778) when the patient’s corneal anatomy caused the Prokera ring to be highly mobile on the eye and not stay in place. It had to be removed immediately.

Comments 0

Views 19

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