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  • 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.

  • 123
    1-20 of 60 results
    Modifiers for Telemedicine Exam Codes
    MAR 23, 2020 in Ask the Expert, Coding Updates, Modifiers, Coding Top 10, Telemedicine
    Question: What modifiers should be added to telemedicine exam codes?
    • Comments 0
    • Views 211
    Billing for Bilateral Tests and Surgeries
    MAR 13, 2020 in Modifiers, Ask the Expert
    Question: How do I bill for bilateral tests and surgeries?
    • Comments 0
    • Views 253
    Surgery Rejection With Modifier -24
    MAR 01, 2020 in Ask the Expert, Coding Updates, Modifiers, Coding Top 10
    Question: One day post-op following cataract surgery on a Medicare patient, the surgeon performed bilateral punctal occlusion with plugs. We billed the appropriate level of exam with modifier -24, indicating the exam was unrelated to the cataract surgery, but the claim was d…
    • Comments 0
    • Views 165
    Reduction in Payment for Higher Allowable Procedure
    MAR 01, 2020 in Modifiers, Glaucoma, Cataract/Anterior Segment, Coding Updates, Coding Top 10, Ask the Expert
    Question: When performing cataract surgery and goniotomy at the same session, I append modifier -51 to cataract surgery, as it has a lower allowable. However, our Medicaid plan has a higher allowable on the cataract surgery, so I append the goniotomy with modifier -51. We re…
    • Comments 0
    • Views 115
    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 1490
    Billing Punctal Plugs for Medicare
    DEC 18, 2019 in Modifiers, Ask the Expert, Cornea
    Question: How should I bill punctal plugs for Medicare patients? We always bill the Eye visit code with modifier -25, along with 68761 -RT and 68761 -LT, however Medicare is no longer processing the claim.
    • Comments 0
    • Views 295
    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 149
    Surgery Requiring General Anesthesia
    SEP 10, 2019 in Cornea, Ask the Expert, Modifiers
    Question: The surgeon performed CPT code 65222 -RT Removal of foreign body, external eye; corneal, with slit lamp under general anesthesia for a pediatric patient. Is there an additional modifier to append?
    • Comments 0
    • Views 164
    Bilateral Punctal Plug Denial
    JUL 31, 2019 in CPT, Cornea, Modifiers, Ask the Expert
    Question: I performed bilateral punctal plugs and submitted to Novitas Medicare CPT code 68761 with modifier -50 and 1 unit. I received a denial due to incorrect modifier. Is there another modifier that should be used?
    • Comments 0
    • Views 398
    Unrelated Exam Same Day as Planned Surgery
    JUL 30, 2019 in Ask the Expert, Cataract/Anterior Segment, Modifiers, Exams
    Question: Our patient, who was scheduled to come today for a YAG Capsulotomy in the right eye, came in with a complaint of blurriness and flashes in the left eye. We did an exam of the left eye and performed the YAG in the right eye. How should we submit?
    • Comments 0
    • Views 183
    Coding Top 10: Billing for Injection Related to Pterygium Surgery, Billing Exams in the Global Period and Resolved Diagnosis Follow-Up
    JUL 12, 2019 in Coding Top 10, Modifiers
    Get trusted answers to your coding questions from the Academy’s coding experts, so you can bill and code with confidence. The July coding selections include: Billing for Injection Related to Pterygium Surgery, Billing Exams in the Global Period and Resolved Diagnosis Follow…
    • Comments 0
    • Views 1187
    Billing Exams in the Global Period
    JUL 08, 2019 in Modifiers, Cataract/Anterior Segment, Exams, Ask the Expert
    Question: A patient 60 days into the global period for cataract surgery has been diagnosed with a post-vitreous detachment (PVD), which may or may not be related. The physician feels this should be billable. Should we append modifier -24?
    • Comments 0
    • Views 440
    Referring Patient to Partner During Global Period
    JUL 08, 2019 in Ask the Expert, Retina, Exams, Modifiers, Cataract/Anterior Segment
    Question: Our patient is in the global period for cataract surgery, and it’s been determined she has cystoid macular edema (CME). We referred her to a retina specialist n our practice. Is the exam billable with modifier -24?
    • Comments 0
    • Views 256
    Billing of Cancelled Surgery
    MAR 18, 2019 in Ask the Expert, Modifiers
    Question: When a patient cancels elective surgery planned for later in the day, can we still bill for the physician’s time?
    • Comments 0
    • Views 432
    Oct. 1 CCI Edits Impact Biopsy and Integumentary Lesion Excision Codes
    OCT 01, 2018 in Oculofacial, Coding Updates, Modifiers
    CMS has released the current Correct Coding Initiative Edits (CCI), Version 24.3, which goes into effect Oct 1. These edits bundle two or more services together. Always look at each code combination when two or more services are being performed as not all codes show a bundle…
    • Comments 0
    • Views 646
    Billing Pterygium Excision with AMT
    AUG 21, 2018 in Cornea, Modifiers, Ask the Expert, CPT
    Question: Can we bill CPT codes 65426 Excision of pterygium; with graft and 65779 AMT sutured together?
    • Comments 0
    • Views 713
    Payment for Usage of Modifiers -62 or -80
    JUL 24, 2018 in CPT, Ask the Expert, Modifiers
    Question: Is there a reduction in payment if an assistant-at surgery is used versus a co-surgeon?
    • Comments 0
    • Views 129
    Order of Modifiers
    JUN 12, 2018 in Modifiers, Ask the Expert, CPT
    Does the modifier order make a difference?
    • Comments 0
    • Views 914
    Comanagement in Another State
    JUN 12, 2018 in Cataract/Anterior Segment, Ask the Expert, Modifiers, CPT
    Can comanagement occur across state lines when there are different Medicare Administrative Contractors?
    • Comments 0
    • Views 58
    Payment for Assistant at Surgery
    JUN 12, 2018 in Ask the Expert, Modifiers, CPT
    Question: My surgeon was an assistant during a procedure with a retina specialist. The operative report clearly states why the assistant was necessary. However, reimbursement was minimal. Any guidance?
    • Comments 0
    • Views 96
    123
    1-20 of 60 results
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