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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Coding Top 10 - November 2022

NOV 14, 2022 in Coding Competency, Coding Top 10, Pediatric/Strabismus, Retina, Trauma Coding, Exams, Cataract/Anterior Segment, Testing Services, Oculofacial, Ask the Expert

The Academy's coding experts answer the top coding questions from the annual meeting.

Comments 0

Views 372

Exam Between Cataract Surgeries

NOV 13, 2022 in Coding Competency, Cataract/Anterior Segment, Exams, Ask the Expert

A patient has cataract surgery on their right eye and comes into the office the next day for their first postoperative appointment. During this appointment, the surgeon planned to go ahead with cataract surgery for the left eye. Can this visit be billed as an evaluation and…

Comments 0

Views 68

Does Lack of Access to Records Warrant Billing Comprehensive Examinations?

NOV 13, 2022 in Exams, Ask the Expert

Following a fire in our main office that affected our server, all records and prior imaging are currently unavailable. This requires that all patients need a comprehensive evaluation to determine their treatment course. Is it appropriate to bill all comprehensive evaluations…

Comments 0

Views 30

How to Perform Internal Chart Audits in 10 Steps

NOV 11, 2022 in Exams, Modifiers, Coding Competency, Ask the Expert, Testing Services

These steps will help you initiate your audit and see you through the entire process from identifying audit targets to implementing a plan to prevent the discovered deficiencies.

Comments 0

Views 154

Coding Top 10 - AAO 2022

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

The Academy's coding experts answer the top coding questions from the annual meeting.

Comments 0

Views 466

Exam Billing When Performing Injections

OCT 20, 2022 in Ask the Expert, Modifiers, Exams, Retina

When can we bill for an exam when an intravitreal injection is performed on the same day?

Comments 0

Views 125

E/M Level 3 or 4

OCT 20, 2022 in Ask the Expert, Exams

What qualifies an exam as a level 3 versus a level 4 evaluation and management (E/M) code?

Comments 0

Views 117

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 536

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 80

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 110

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 125

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 31

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 56

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 953

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 74

Nasolacrimal Stent Removal

AUG 12, 2022 in Exams, Pediatric/Strabismus, Ask the Expert

A pediatric ophthalmologist in another state placed bilateral nasolacrimal stents under anesthesia for a child who subsequently moved to my state. I saw the child and removed the stents in the office. How should I code for the stent removal?

Comments 0

Views 75

Telehealth Billing

AUG 12, 2022 in Exams, Telemedicine, Ask the Expert

Over the weekend, an established patient contacted the ophthalmologist about an issue the patient was experiencing. The physician attempted to set up a telehealth conference since the patient couldn’t meet at the doctor’s office. However, the patient did not have access to v…

Comments 0

Views 89

Coding Top 10 - July 2022

JUL 19, 2022 in Cataract/Anterior Segment, Glaucoma, Testing Services, Coding Top 10, ICD-10, Diabetes, CPT, Exams, Modifiers, Retina, Ask the Expert, Coding Competency

Get trusted answers to your coding questions from the Academy's coding experts, so you can bill and code with confidence.

Comments 0

Views 640

Local Coverage Determination Policies (LCDs)

JUL 18, 2022 in Ask the Expert, Testing Services, Coding Competency, Exams, Retina, Diabetes, Coding Top 10

We are having trouble getting paid for OCTs. How would I know if my Medicare administrative contractor (MAC) has a policy?

Comments 0

Views 247

Social Determinants of Health

JUL 18, 2022 in Ask the Expert, Exams, Coding Competency, Coding Top 10

Is there any guidance on reporting ICD-10-CM codes for social determinants of health in ophthalmology?

Comments 0

Views 66

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