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 58 results
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CAAP Recoupment on Medicare Claims

MAY 13, 2021 in Regulatory News

Ophthalmic practices who received a COVID Accelerated/Advance Payments (CAAP) from CMS will start to see a new physician adjustment amount on their remittance advice.

Comments 0

Views 251

Stay Current with Payer Policies

APR 29, 2021 in Ask the Expert, Regulatory News

While any service you perform the most may be an audit target, you are most likely to be audited on something that has a published policy. Research each payer to see what they require and ensure your documentation exceeds expectations.

Comments 0

Views 139

Coding for Phone Calls, Internet and Telehealth Consultations

APR 16, 2021 in Coding Updates, Regulatory News, Telemedicine

There are new coding guidelines for ophthalmic practices that want to bill for telehealth and other communications-based technology services.

Comments 0

Views 191140

What to Do When Receiving a Comparative Billing Report from Any Payer

APR 13, 2021 in Ask the Expert, Regulatory News

Q: What do I do when I receive a comparative billing report?

Comments 0

Views 980

How to Use the Advance Beneficiary Notice 2020 Edition

JUN 24, 2020 in Regulatory News

Effective Aug. 30, 2020 CMS requires all practices to use an updated version of form CMS-R-131, known as the Advance Beneficiary Notice or ABN. The change is a good opportunity to review appropriate use of the form.

Comments 0

Views 5471

Coding Physician Visits in Skilled Nursing Facilities/Nursing Facilities

APR 22, 2020 in Telemedicine, Regulatory News, Coding Updates

As of April 22, 2020, due to the COVID-19 pandemic, CMS is waiving the requirement to perform in person visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth options.

Comments 0

Views 1646

CMS Relief Grant: Balance Billing Stipulation Due to COVID-19 Pandemic

APR 21, 2020 in Regulatory News, Telemedicine, Coding Updates

As of April 21, HHS changed their terms and conditions regarding the balanced billing requirement due to the COVID-19 pandemic.

Comments 0

Views 271

New Medicare Cards Sent to Beneficiaries

JAN 31, 2019 in Coding Updates, Regulatory News

It’s time to start using the new Medicare Beneficiary Identifier (MBI) since patients have been issued new cards.

Comments 0

Views 67

MBI Reason Codes on Remittance Advice

AUG 29, 2018 in Regulatory News, Coding Updates

As beneficiaries begin receiving their new Medicare cards, practices are seeing a new code, “N793” on their remittance advice. This new code will not impact payment and is informational only.

Comments 0

Views 766

July 2018 CCI Edits Do Not Impact Ophthalmology

JUN 26, 2018 in CPT, Regulatory News, Coding Updates

CMS has released the current Correct Coding Initiative Edits (CCI), Version V24.2, which goes into effect July 1. However, there is no impact to ophthalmology.

Comments 0

Views 179

CMS Alerts Ophthalmologists of Incorrect Usage of Quality Measure

MAY 29, 2018 in Exams, Regulatory News

Some ophthalmologists are continuing to use an incorrect Healthcare Common Procedure Coding System (HCPCS) code for measure 14 Dilated macular exam, a problem that originally was due to a failure by the Centers for Medicare & Medicaid Services.

Comments 0

Views 460

How to Bill for Patients Seen While Incarcerated

APR 10, 2018 in Regulatory News

Patients in the penal system have eye care needs, just like the rest of the population. But when an ophthalmologist treats such patients, it’s not always clear whom to bill.

Comments 0

Views 2748

Audit Watch: What to Do if You’re a Palmetto Outlier

APR 04, 2018 in Regulatory News

Medicare administrative contractor Palmetto has recently sent comparative billing reports to practices in North Carolina, South Carolina, Virginia and West Virginia. If you received a letter indicating you are an outlier in certain areas, Palmetto wants you to submit additio…

Comments 0

Views 223

When to Expect New Medicare Cards

APR 03, 2018 in Regulatory News

Starting April 2018, Medicare beneficiaries start receiving new insurance cards with a unique identifier, not their Social Security number. You can continue submitting claims with the existing Social Security number through 2019, but your internal systems should be ready to…

Comments 0

Views 213

Minor Ophthalmology Bundling Changes for CCI Edits Effective April 1, 2018

MAR 26, 2018 in Regulatory News, Coding Updates, CPT

The current Correct Coding Initiative edits, effective April 1, 2018, have minor consequence for ophthalmology. The Centers for Medicare and Medicaid Services now bundles the CPT code 14061 with CPT codes 67961, 67966 and 67971.

Comments 0

Views 1367

CMS Provider-Revalidation List Updated Through September 2018

MAR 13, 2018 in Regulatory News

Under the Affordable Care Act, all physicians must periodically revalidate their Medicare enrollment to avoid a disruption in reimbursement. The Centers for Medicare and Medicaid Services has now posted providers who are due to revalidate through Sept. 31, 2018.

Comments 0

Views 296

TPE Audits Target Emergency Department Exams: Code Correctly

JAN 17, 2018 in Regulatory News, Pediatric/Strabismus

Targeted Probe and Educate audits are currently focused on emergency department CPT codes 99283, 92284 and 99285. The timing is right to review the documentation requirements.

Comments 0

Views 134

Latest CCI Edits Bundle Oculofacial Codes 15730, 15733

JAN 04, 2018 in Regulatory News, Oculofacial

The Correct Coding Initiative edits, V24.0 effective Jan. 1, 2018, have limited effect on ophthalmology, compared to previous quarters. The only edits affect two new oculofacial surgical codes: CPT code 15730 and CPT code 15733.

Comments 0

Views 3700

Dec. 31 Deadline to Change Medicare Participation Status

DEC 14, 2017 in Regulatory News

Physicians who choose to change their participation status with Medicare must do so before Dec. 31. If you do not want to change your status, you do not need to do anything. As a reminder, you have three options for participation with Medicare Part B: participation, non-part…

Comments 0

Views 72

2017 ICD-10 Changes Expand Myopic Degeneration, Vision-Rehabilitation Codes

OCT 05, 2017 in Regulatory News, ICD-10

About 50 new ICD-10 codes affecting ophthalmology went into effect Oct. 1, 2017. The most significant updates expand the codes for myopic degeneration and vision rehabilitation. Medicare contractors are in the process of updating their policies to reflect the new codes.

Comments 0

Views 2306

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