Coding News and Expert Advice

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1-20 of 54 results

Coding Top 10: Usage of miLoop in Cataract Surgery, CPT Code for Swabbing Cornea and Complex Retina Repair without Membrane Peel

AUG 01, 2019 in Retina, Oculofacial, Exams, Cornea, Coding Top 10, Modifiers, Testing Services, Cataract/Anterior Segment, CPT

Get trusted answers to your coding questions from the Academy’s coding experts, so you can bill and code with confidence. The August coding selections include: Usage of miLoop in Cataract Surgery, CPT Code for Swabbing Cornea and Complex Retina Repair without Membrane Peel

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Views 747

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 105

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?

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Views 79

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 Retina, Testing Services, CPT, Cataract/Anterior Segment, Exams, Cornea, Coding Top 10, Glaucoma, Modifiers, Oculofacial

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 1001

Referring Patient to Partner During Global Period

JUL 08, 2019 in Ask the Expert, Retina, Testing Services, 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 198

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 303

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 155

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…

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Views 573

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 348

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 97

Order of Modifiers

JUN 12, 2018 in Modifiers, Ask the Expert, CPT

Does the modifier order make a difference?

Comments 0
Views 745

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 53

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 68

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 172

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 194

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 135

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 332

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 291

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 916

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 1231

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