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.
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Coding Top 10 - June 2022

MAY 31, 2022 in CPT, Cataract/Anterior Segment, Coding Updates, Diabetes, Ask the Expert, Testing Services, Exams, Oculofacial, ICD-10, Retina, Glaucoma, 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.

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Coding Top 10 - May 2022

APR 22, 2022 in ICD-10, Exams, Ask the Expert, Coding Updates, Glaucoma, Coding Competency, Retina, Coding Top 10, Modifiers, CPT, Cataract/Anterior Segment, Oculofacial

Get trusted answers to your coding questions from the Academy's coding experts, so you can bill and code with confidence.

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Comanagement and Post-Operative Billing

APR 22, 2022 in Modifiers, Exams, Coding Top 10, Ask the Expert

Can we abstain from billing the days/visits that we see post-ops in order to not disrupt the referring and comanaging billing for the full 90 days? Or are we required to bill for the days that the patient is under our care?

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Lesion Removal MUEs

APR 22, 2022 in Ask the Expert, Oculofacial, Modifiers, Coding Top 10

Patient had lesions removed on all four eyelids. MUE states it is three. Can we bill two separate line items each with a 50 modifier?

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Coding Top 10 - April 2022

MAR 31, 2022 in Coding Competency, Modifiers, Coding Updates, Glaucoma, Ask the Expert, Pediatric/Strabismus, Cataract/Anterior Segment, CPT, ICD-10, Exams, Oculofacial, Retina, Coding Top 10

Get trusted answers to your coding questions from the Academy's coding experts, so you can bill and code with confidence.

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Does This Support Modifier -59?

MAR 30, 2022 in Modifiers, Cataract/Anterior Segment, Ask the Expert, Coding Top 10

A physician performed complex cataract surgery 66982 OS on a patient and in the same session performed a 67005 OS. The op note reads: “One strand of vitreous was seen inferior-nasally so the anterior vitrectomy instrument was used to remove it.” Does this documentation sup…

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Is It Appropriate to Append Modifier -77 to a Diagnostic Test?

MAR 30, 2022 in Ask the Expert, Modifiers, Coding Top 10

Optical coherence tomography (OCT) was performed by an ophthalmologist, who then referred the patient to a retina specialist. The retina specialist performed and interpreted an OCT as well. Can we append modifier -77 in this scenario?

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Unilateral Contact Lens Fit

MAR 30, 2022 in Modifiers, Coding Top 10, Ask the Expert

CPT 92072 (fitting of contact lens for keratoconus) has a bilateral surgery indicator of “2” in Medicare’s database. Is it correct not to use modifier -50 and if one eye is fitted, use modifier -52?

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During the pandemic, when patients had to be seen virtually, we were able to bill a video/telehealth appointment. Are we able to continue billing for telehealth visits?

MAR 15, 2022 in Exams, Modifiers, Telemedicine, Ask the Expert, Coding Top 10

During the pandemic, when patients had to be seen virtually, we were able to bill a video/telehealth appointment. Are we able to continue billing for telehealth visits?

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Coding Top 10 - March 2022

MAR 03, 2022 in Coding Top 10, Coding Updates, Pediatric/Strabismus, Glaucoma, Coding Competency, ICD-10, Cataract/Anterior Segment, CPT, Modifiers, Exams, Oculofacial, Ask the Expert, Retina

Get trusted answers to your coding questions from the Academy's coding experts, so you can bill and code with confidence.

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Is there a modifier code we can use to bill cataract surgery after a superficial keratectomy has been done without waiting the standard 90-day global period?

MAR 02, 2022 in Cornea, Ask the Expert, Modifiers, Cataract/Anterior Segment, Coding Top 10

Is there a modifier code we can use to bill cataract surgery after a superficial keratectomy has been done without waiting the standard 90-day global period?

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Modifiers to append for payment on additional treatments

MAR 02, 2022 in Coding Top 10, Modifiers, Coding Competency, Ask the Expert

A physician performs CPT code 65810 Paracentesis of anterior chamber of eye (separate procedure); with removal of vitreous and/or discission of anterior hyaloid membrane, with or without air injection multiple times on different days for ocular hypertension following a surge…

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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.

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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.

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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?

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Billing for Bilateral Tests and Surgeries

MAR 13, 2020 in Modifiers, Ask the Expert

Question: How do I bill for bilateral tests and surgeries?

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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…

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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…

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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

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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.

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