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 117 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 243

Payer denying our claim because they paid claim from another specialist for the same date of service. Should we be paid too?

SEP 22, 2021 in Exams, Ask the Expert

Payor denying our claim because they paid claim from another specialist for the same date of service. Should we be paid too?

Comments 0

Views 33

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 134

Patient Status When Billing Different Payers

MAY 13, 2021 in Ask the Expert, Exams

Does the routine vision exam reset the new patient clock so today’s medical exam can be billed as a new patient exam?

Comments 0

Views 71

Corneal Laceration - Coding for Ocular Trauma case study

APR 20, 2021 in Trauma Coding, ICD-10, Exams, Ask the Expert, CPT, E/M

First day on the job at a home improvement store, an 18-year-old cuts the metal band around layers of stacked wood. The metal band flipped lacerating his cheek to forehead, including eye on the left side of his face.

Comments 0

Views 223

Canalicular Laceration - Coding for Ocular Trauma case study

APR 20, 2021 in Exams, Trauma Coding, CPT, ICD-10, E/M, Ask the Expert

Exam revealed right lower canalicular laceration from wire hidden in lawn.

Comments 0

Views 104

Commotio Retina Involving Macula - Coding for Ocular Trauma case study

APR 20, 2021 in Ask the Expert, CPT, E/M, ICD-10, Trauma Coding, Exams

8-year-old nephew of retina specialist was hit in left eye with soccer ball. Immediately complained of decreased vision.

Comments 0

Views 98

Patient Fees During Global Period

MAR 05, 2021 in Ask the Expert, Exams, Coding Competency

Q: For exams, tests or surgeries that are submitted to the payer during the global period, does the patient have out-of-pocket expenses associated?

Comments 0

Views 156

Prescription Definition for Medical Decision Making

MAR 05, 2021 in Ask the Expert, E/M, Exams

Q: Will refraction or contact lens prescription count as moderate for medical decision-making?

Comments 0

Views 316

Moderate Decision Making for Medically Necessary Surgery

MAR 05, 2021 in Exams, Ask the Expert, E/M

Q: When any surgery is determined to be medically necessary, such as cataract surgery or entropion, but the patient defers surgery, are we still able to meet moderate medical decision-making?

Comments 0

Views 265

Billing 99215 for Same Day Exam as Surgeon

MAR 05, 2021 in E/M, Ask the Expert, Exams

Q: If our physician determines a patient has a retinal detachment and refers the patient to a retina surgeon on the same day, should we submit 99215?

Comments 0

Views 157

Billing CPT code 99058

MAR 05, 2021 in Exams, Ask the Expert, CPT, E/M

Q:We have never submitted CPT code 99058 Service(s) provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service for patients seen when our local hospital refers them. How should we submit?

Comments 0

Views 317

Billing Telemedicine Emergency Exam and Follow-up

MAR 05, 2021 in CPT, Telemedicine, Ask the Expert, Exams

Q: Are we able to submit a telemedicine exam for a medical emergency on the weekend and then have the patient come into the office the following Tuesday and submit an office exam?

Comments 0

Views 55

Countdown to New E/M Requirements: Preparation for January 1

DEC 01, 2020 in Exams, Ask the Expert, E/M

The Academy has your implementation strategy for the new evaluation and management (E/M) changes, so that your practice is ready on Jan. 1. Use these steps to ensure your practice has a smooth transition. You can find further education at aao.org/em.

Comments 0

Views 602

Do non-covered tests count in MDM

NOV 06, 2020 in Exams, Ask the Expert, E/M

Question: Is the refraction, Amsler grid, glare testing, etc., considered tests for amount and/or complexity of data to be reviewed an analyzed with the new E/M documentation criteria?

Comments 0

Views 404

Countdown to New E/M Requirements: Medically Relevant History

NOV 04, 2020 in Ask the Expert, Exams, E/M

With the new requirements of evaluation and management (E/M) beginning Jan. 1, 2021, we can no longer keep documenting as we always have. So how do you begin making the change? These five steps will guide you on your journey.

Comments 0

Views 1351

Billing for Smoking Cessation Counseling

NOV 02, 2020 in E/M, Exams, Ask the Expert

I was made aware there are two CPT codes for smoking cessation counseling. Are they appropriate for ophthalmologists to use?

Comments 0

Views 879

EUA Same Day and Lens Removal

NOV 02, 2020 in Exams, Pediatric/Strabismus, Ask the Expert

Our pediatric surgeon performed an exam under anesthesia (EUA) along with removal of a cataract without implantation of IOL. We submitted the following but received a denial: 92018 -57 66850 -RT How should we submit?

Comments 0

Views 86

Billing Irrigation for Chemical Injury

NOV 02, 2020 in E/M, Ask the Expert, Exams

Our physician irrigated a patient’s eyes using the Morgan lens device after a chemical injury. Is this separately billable?

Comments 0

Views 181

Superglue to Eye

NOV 02, 2020 in Ask the Expert, E/M, Exams

Question: Our patient got superglue in their right eye. Our physician examined the patient and debrided the lashes. What CPT code is billed for the removal of glue from lashes?

Comments 0

Views 914

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