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 128 results
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Glaucoma Screening Benefits Reminder

JAN 05, 2022 in Glaucoma, Ask the Expert, Exams

Carrier Medical Directors for Part B Medicare would like all ophthalmologists and their staff to recall the components of the glaucoma screening benefit.

Comments 0

Views 146

Congratulations to OCS and OCSR Designees

DEC 08, 2021 in Modifiers, Cornea, Pediatric/Strabismus, Cataract/Anterior Segment, Coding Updates, CPT, Exams, Glaucoma, Testing Services, ICD-10, Oculofacial, Coding Competency, Retina

Individuals who who have passed the Ophthalmic Coding Specialist and/or Ophthalmic Coding Specialist Retina exams.

Comments 0

Views 181

Coding Top 10 - November 2021

NOV 04, 2021 in Glaucoma, Cataract/Anterior Segment, Ask the Expert, Coding Updates, Exams, Pediatric/Strabismus, Coding Top 10, ICD-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 1204

Billing when not the attending physician

NOV 04, 2021 in Exams, Ask the Expert

One of our physicians was called in to check a patient while she was in observation care. We are not the attending physician. How do we bill for this as an ophthalmologist?

Comments 0

Views 110

Billing exam with visual fields

NOV 04, 2021 in Ask the Expert, Exams, Glaucoma

A patient is a glaucoma suspect and has bilateral nuclear cataracts. The visual fields ordered and performed today are stable. Should this be billed at 99214 because there are two stable chronic diseases, and a visual field was ordered, and the results interpreted?

Comments 0

Views 304

Level of E/M documentation

NOV 04, 2021 in Exams, Glaucoma, Ask the Expert

A patient has stable primary open angle and nuclear cataracts, and the plan is to continue glaucoma meds and observe cataracts. What level of E/M does documentation support?

Comments 0

Views 234

Denials regarding certain ICD-10 codes

NOV 04, 2021 in Ask the Expert, Exams

I have been getting denials from payers regarding certain ICD-10 codes that cannot be billed together. Example: H16.223 Keratoconjunctivitis sicca, not specified as Sjogren’s bilateral and M35.01 Sjogrens’s syndrome.

Comments 0

Views 177

Billing services for patient who is new to our practice but not to the physician

NOV 04, 2021 in Ask the Expert, Exams

The claims for one of our doctors who has been with our group for over a year keep getting denied when we bill for new patients. The patients were examined at the physician’s previous office, which has no connection to ours. How can we get paid for new patients at our office…

Comments 0

Views 87

Changes in CPT language for 99211

NOV 04, 2021 in Exams, Ask the Expert, Cataract/Anterior Segment

Has the CPT language for 99211 changed over the past few years?

Comments 0

Views 179

If the physician manually squeezes the patient’s lids, is there a separate CPT code to submit?

OCT 04, 2021 in Ask the Expert, Exams, Testing Services

If the physician manually squeezes the patient’s lids, is there a separate CPT code to submit.?

Comments 0

Views 61

When we perform any category III or miscellaneous code when diagnosing and/or treating MGD or DED, do we need a modifier on the exam performed the same day?

OCT 04, 2021 in Exams, Testing Services, Ask the Expert

When we perform any category III or miscellaneous code when diagnosing and/or treating MGD or DED, do we need a modifier on the exam performed the same day?

Comments 0

Views 19

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 793

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 89

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 148

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 77

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 264

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 127

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 127

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 162

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 387

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