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.
1-20 of 64 results
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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 0

Please clarify the current bundling policy or if these codes can be billed as separate procedures? Do we use 67903 or 67904 Ptosis and 15823 Blepharoplasty?

SEP 22, 2021 in Oculofacial, Ask the Expert

Please clarify the current bundling policy or if these codes can be billed as separate procedures? Do we use 67903 or 67904 Ptosis and 15823 Blepharoplasty?

Comments 0

Views 0

When performing external ocular photography of patients prior to upper lid blepharoplasties, must the picture itself be tagged by patient name, chart number and date of service?

SEP 08, 2021 in Testing Services, Oculofacial, Ask the Expert

When performing external ocular photography of patients prior to upper lid blepharoplasties, must the picture itself be tagged by patient name, chart number and date of service?

Comments 0

Views 6

HOPD Prior Authorization Tracking Number

AUG 14, 2020 in Oculofacial, Ask the Expert

We are performing a blepharoplasty in the hospital outpatient department and have received a provisional affirmation to proceed. Does the surgeon’s claim require the 14-digit UTN?

Comments 0

Views 44

ICD-10 Code for Inferior Oblique Overaction

AUG 14, 2020 in ICD-10, Pediatric/Strabismus, Ask the Expert, Oculofacial

I am searching for an inferior oblique overaction ICD-10 diagnosis code.

Comments 0

Views 568

Frequency of punctal plugs

AUG 14, 2020 in Ask the Expert, Oculofacial

We have a patient requesting quick-dissolving plugs, which require reinsertion monthly. How often can we insert punctal plugs on a single patient?

Comments 0

Views 127

Prior Authorization for Medicare

JUN 24, 2020 in Ask the Expert, Oculofacial

I recently heard Medicare requires a prior authorization on blepharoplasties. In the past we’ve been unable to prior authorize services with Medicare. Is this new?

Comments 0

Views 97

Prior Authorization of Blepharoplasty and Botox Procedures Required Starting July 1

JUN 03, 2020 in Oculofacial, Ask the Expert

Hospital outpatient departments must preauthorize blepharoplasty and Botox procedures performed on or after July 1, but the process can begin June 17.

Comments 0

Views 2971

Unsuccessful Probing of Nasal Lacrimal Duct

MAR 01, 2020 in Coding Updates, CPT, Ask the Expert, Coding Top 10, Oculofacial

Question: Our surgeon dilated and probed the patient’s right lacrimal duct. However, the probing was unsuccessful. Should we submit CPT code 68810 Probing of nasolacrimal duct, with or without irrigation, with modifier -52 for reduced services?

Comments 0

Views 172

Coding Top 10: Frequency of Retina OCT, Frequency of Billing Fundus Photography and Superglue to Eye

MAR 01, 2020 in Testing Services, Exams, Cataract/Anterior Segment, Coding Top 10, Oculofacial, Ask the Expert, Glaucoma, Modifiers, Coding Updates

Get trusted answers to your coding questions from the Academy’s coding experts, so you can bill and code with confidence. The March coding selections include: Frequency of Retina OCT, Frequency of Billing Fundus Photography and Superglue to Eye

Comments 0

Views 2394

Adjustment to Frontalis Sling

DEC 18, 2019 in Oculofacial, Ask the Expert

Question: How do you bill for frontalis sling adjustment?

Comments 0

Views 645

ICD-10 Code for Squamous Cell Carcinoma of Skin of Eyelid

DEC 18, 2019 in Ask the Expert, Oculofacial

Question: Is ICD-10 code C44.12- Squamous cell carcinoma of skin of eyelid, including canthus really C44.122 for the right eyelid and C44.129 for the left eyelid?

Comments 0

Views 107

CPT Code for Globe Exploration

DEC 11, 2019 in Ask the Expert, Oculofacial

Question: Our surgeon performed an exploration of the left globe on a patient who was thought to may have a ruptured globe due to blunt trauma, but fortunately none was found. The surgeon did not explore the orbit, only the globe. What CPT code should be billed?

Comments 0

Views 2872

CPT code 15004 Denied by Medicare

DEC 11, 2019 in Ask the Expert, Oculofacial

Question: Our surgeon performed and billed for CPT code 67966 Excision and repair of eyelid, along with 15004 Surgical preparation of recipient site. Medicare denied 15004. The surgeon feels this is incorrect. Should we have billed this differently?

Comments 0

Views 652

ICD-10 Code for Orbital Roof Fracture

DEC 11, 2019 in Ask the Expert, Oculofacial

Question: Is there a diagnosis code for orbital roof fracture?

Comments 0

Views 137

Dry Eye Diagnosis for Epilation

NOV 06, 2019 in ICD-10, Oculofacial, Cornea, Ask the Expert

Question: Our physician performed epilation with a primary diagnosis of dry eyes; however, we have not seen this diagnosis attached to this procedure before. Is this payable?

Comments 0

Views 432

Terminated Ptosis Repair Billing

NOV 06, 2019 in Ask the Expert, Oculofacial

Question: Our surgeon was performing ptosis surgery of the right eye, when the eyelid tissue proved to be too thin and fragile. The tissue superficial to the Wright needle and fascia tore, leaving the needle/fascia complex exposed. It was decided that proceeding further with…

Comments 0

Views 97

Payer Denial of Exam Same Day as Minor Surgery

NOV 06, 2019 in Oculofacial, Ask the Expert, Modifiers

Question: Our commercial payer denied our exam submitted the same day as an excision of lid lesion. They stated it was incidental to the primary procedure. Below is how we submitted. Should we rebill or appeal? Diagnosis D23.121 Benign eyelid lesion CPT: 92014 - 25…

Comments 0

Views 194

Units for CPT code 67882

JUL 31, 2019 in Ask the Expert, CPT, Oculofacial

Question: Our surgeon performed CPT code 67882 Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; with transposition of tarsal plate on a patient’s right eye. However, this was performed both on medial and lateral eyelid. Is there another CPT cod…

Comments 0

Views 470

Visual Field Billing for Lid Surgery

JUL 08, 2019 in Ask the Expert, Testing Services, CPT, Oculofacial

Question: We billed 92083 Visual field to a commercial payer with a diagnosis of dermatochalasis and were paid, but our billing manager stated this visual field should not have been submitted.

Comments 0

Views 362

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