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 61 results
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Determining the correct modifier

JUL 21, 2021 in Modifiers, Ask the Expert

We need help determining the correct modifier to use on a claim.

Comments 0

Views 234

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 290

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 622

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 243

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 202

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 2403

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 1123

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 194

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 368

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 691

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 352

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 1257

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 555

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 331

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 683

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 706

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 1429

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 192

Order of Modifiers

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

Does the modifier order make a difference?

Comments 0

Views 1012

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 68

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