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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 48 results
    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 112
    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 567
    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 254
    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 87
    Order of Modifiers
    JUN 12, 2018 in Modifiers, Ask the Expert, CPT
    Does the modifier order make a difference?
    • Comments 0
    • Views 662
    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 49
    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 64
    Billing for Emergency Cancellation of Surgery
    APR 24, 2018 in Ask the Expert, Modifiers
    We saw a patient in our ASC for surgery. During the preoperative administration of medication, his hypertension presented a complication where we couldn't get his blood pressure under control. Instead of surgery, we had to send him to the emergency department. Can the facili…
    • Comments 0
    • Views 165
    Billing Unilateral Services with Bilateral Diagnoses
    APR 24, 2018 in Modifiers, CPT, Ask the Expert
    Commercial payers denied our services when we appended modifiers -RT or -LT, but the diagnosis is a bilateral code. Should we appeal?
    • Comments 0
    • Views 186
    Billing for 2 Shunts in the Same Eye
    APR 24, 2018 in Modifiers, CPT, Glaucoma, Ask the Expert
    The payer denied CPT code 66185 Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft when billed on separate lines for both superior and inferior tubes in the right eye. Should we have submitted with modifier -50 instead?
    • Comments 0
    • Views 121
    Billing Exams Without Insurance Credentialing
    MAR 22, 2018 in Testing Services, Modifiers, Ask the Expert, Exams
    We have a new physician joining our practice sooner than her license is available and prior to credentialing. Can we bill under the group with a specific modifier? I heard about locum tenens.
    • Comments 0
    • Views 301
    Usage of Modifier -52
    MAR 22, 2018 in Testing Services, Ask the Expert, Modifiers
    I’ve read that if we perform a test on one eye, we need to append modifier -52, but I am not finding much data on this. Language I’ve read from the Academy states not to append. Can you clarify?
    • Comments 0
    • Views 272
    Appropriate Modifier for Surgery in Global Period
    FEB 21, 2018 in CPT, Modifiers, Ask the Expert
    Our ophthalmologist performed a YAG laser vitreolysis within the global period of a YAG capsulotomy (CPT code 66821). Should we append modifier -59 to CPT code 67031 YAG vitreolysis? The diagnoses are different.
    • Comments 0
    • Views 847
    Academy Announces New Retina-Specific OCS Exam
    FEB 01, 2018 in Exams, Coding Updates, Oculofacial, Pediatric/Strabismus, Glaucoma, Diabetes, Testing Services, Cornea, Cataract/Anterior Segment, Modifiers, Retina
    Effective April 2, the Academy will administer the Ophthalmic Coding Specialist examination and offer a new retina-specific version.
    • Comments 0
    • Views 1186
    Billing Comanagement
    NOV 28, 2017 in Cataract/Anterior Segment, Modifiers, Ask the Expert
    How do we submit the claim when we are comanaging CPT code 66984 Cataract extraction with IOL and the surgeon sees the patient for the first 10 days?
    • Comments 0
    • Views 880
    Additional Service for Foreign Body Removal
    NOV 28, 2017 in Ask the Expert, CPT, Cornea, Modifiers
    Our surgeon performed a conjunctival foreign body removal in the ambulatory surgery center. This was previously attempted in the office setting, however the patient passed out. Since the conjunctiva healed over, the surgeon was required to cut that portion out as well as cau…
    • Comments 0
    • Views 1137
    Payer Guidelines for Comanagement
    NOV 28, 2017 in Modifiers, Ask the Expert
    When pterygium excision is performed, and the payer does not recognize the comanagement modifiers, is there a way for the comanaging physician to get reimbursed?
    • Comments 0
    • Views 140
    Unrelated Exam Day Before Planned Surgery
    NOV 28, 2017 in Modifiers, CPT, Ask the Expert
    A patient is having a pre-scheduled Yag laser today. We saw her yesterday, as a work-in for a subconjunctival hemorrhage. Does that work-in visit need a modifier since it was yesterday?
    • Comments 0
    • Views 165
    Unbundling Pars Plana Vitrectomy and Prophylaxis of Retinal Detachment
    AUG 03, 2017 in Ask the Expert, CPT, Modifiers, Retina
    Can we unbundle CPT codes 67036 Pars plana vitrectomy and 67145 Prophylaxis of retinal detachment; photocoagulation with modifier -59 when performed simultaneously with or without tear?
    • Comments 0
    • Views 314
    IOL Biometry Use of -TC and -26
    AUG 03, 2017 in Testing Services, CPT, Ask the Expert, Modifiers
    Should our practice bill IOL biometry with modifiers -TC for the technical component and -26 for the professional component?
    • Comments 0
    • Views 846
    123
    1-20 of 48 results
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