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 often. Academy coding advice is based on current information. 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 - March 2023

MAR 10, 2023 in Retina, Testing Services, Exams, CPT, Cornea, Pediatric/Strabismus, Coding Competency, Cataract/Anterior Segment, Modifiers, Coding Top 10, Oculofacial

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

Comments 0

Views 439

Documentation Location for Activities of Daily Living

MAR 10, 2023 in Coding Competency, Ask the Expert, Exams, Cataract/Anterior Segment

For cataract surgery, where do we document the patient’s specific activity of daily living (ADL) that is affected?

Comments 0

Views 72

Assistant to Surgery Modifier

MAR 10, 2023 in Modifiers, Ask the Expert, Cataract/Anterior Segment

Our surgeon performed complex cataract surgery with a retina surgeon. Our practice management billing software does not accept modifier -62 with CPT 66982. Can we bill the surgery with modifier 62?

Comments 0

Views 25

Failure to Document Medical Necessity Continues

FEB 15, 2023 in Ask the Expert, Cataract/Anterior Segment

Prepayment provider-specific probe results from Palmetto GBA reveal insufficient documentation continues to plague providers.

Comments 0

Views 219

Coding Top 10 - February 2023

FEB 03, 2023 in Retina, Oculofacial, Cataract/Anterior Segment, Coding Competency, Coding Top 10, Cornea, CPT

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

Comments 0

Views 659

Planning for Complex Cataract Surgery

FEB 03, 2023 in Cataract/Anterior Segment, Ask the Expert, CPT

A patient has phacodonesis and is scheduled for complex cataract surgery. There is no mention of sutures, Malyugin ring or hyper mature cataract in the exam notes. In documenting the surgical order, is it better to plan for complex and down code or plan for standard and up c…

Comments 0

Views 152

Coding Top 10 - January 2023

JAN 20, 2023 in Exams, Oculofacial, Coding Competency, Cataract/Anterior Segment, Modifiers, Ask the Expert, E/M, Coding Top 10, Retina, Testing Services, CPT

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

Comments 0

Views 568

Reimbursement for CPTs 66987 and 66988

JAN 19, 2023 in CPT, Cataract/Anterior Segment, Ask the Expert, Coding Competency, Glaucoma

Is there wRVU and reimbursement information from CMS for combo CPT codes 66987 and 66988?

Comments 0

Views 88

Diabetic Cataract Patient

JAN 19, 2023 in Ask the Expert, Testing Services, CPT, Cataract/Anterior Segment

A physician ordered an OCT to confirm the retina of a diabetic cataract patient was normal and not contributing to poor vision. Can we bill if pathology is found?

Comments 0

Views 62

Congratulations to OCS and OCSR Designees

JAN 02, 2023 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.

Comments 0

Views 698

You Better Watch Out — Auditors Are Checking Their Lists Twice

DEC 05, 2022 in Cataract/Anterior Segment, Retina, Coding Competency, Ask the Expert

The Centers for Medicare & Medicaid Services (CMS) contracts with a Supplemental Medical Review Contractor (SMRC) and partnering Noridian as the national contractor, to help lower improper payment rates by conducting post-payment audits.

Comments 0

Views 373

Coding Top 10 - December 2022

DEC 01, 2022 in Coding Top 10, Testing Services, Coding Competency, Exams, E/M, Retina, Cataract/Anterior Segment, Oculofacial, Ask the Expert, CPT, Modifiers

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

Comments 0

Views 506

Documenting the Need for YAG Capsulotomy — First Coast

DEC 01, 2022 in Cataract/Anterior Segment, Ask the Expert

We received a comparative billing report noting us as outliers for YAG capsulotomy (CPT code 66821). On First Coast’s website it says the local coverage determination (LCD) for 66821 has been retired. On what guidelines should we base our documentation?

Comments 0

Views 92

How to Bill for Co-Managed Cataract Patients

DEC 01, 2022 in Coding Competency, Cataract/Anterior Segment, Ask the Expert, Modifiers

When our ophthalmologist sees the patient for post-op day one is it appropriate to bill 66984 –54 and no additional post-op days? Is reimbursement different when the surgeon performs 2 weeks of postop care and before transferring care to the co-managing provider?

Comments 0

Views 135

Complex Cataract Operative Report

NOV 30, 2022 in Ask the Expert, Cataract/Anterior Segment

Our ambulatory surgery center has an operative report template with the option to check a box at the end of the report if trypan, capsular tension ring or iris hooks were used during the case, making it complex. Is it sufficient to check the appropriate box or does it also n…

Comments 0

Views 308

Coding Top 10 - November 2022

NOV 14, 2022 in Coding Competency, Coding Top 10, Pediatric/Strabismus, Retina, Trauma Coding, Exams, Cataract/Anterior Segment, Testing Services, Oculofacial, Ask the Expert

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

Comments 0

Views 531

Pediatric Cataract Surgery

NOV 13, 2022 in Cataract/Anterior Segment, Pediatric/Strabismus, Ask the Expert

What is the age limit for billing 66982 for pediatric patients?

Comments 0

Views 28

What Constitutes a Complex Cataract Surgery Case?

NOV 13, 2022 in Ask the Expert, Cataract/Anterior Segment

What constitutes a complex cataract surgery case?

Comments 0

Views 397

Exam Between Cataract Surgeries

NOV 13, 2022 in Coding Competency, Cataract/Anterior Segment, Exams, Ask the Expert

A patient has cataract surgery on their right eye and comes into the office the next day for their first postoperative appointment. During this appointment, the surgeon planned to go ahead with cataract surgery for the left eye. Can this visit be billed as an evaluation and…

Comments 0

Views 223

Unable to Implant Intraocular Lens (IOL)

NOV 13, 2022 in Coding Competency, Ask the Expert, Cataract/Anterior Segment

During cataract surgery, the patient's capsule ruptured due to weak zonules. The IOL could not be implanted. What is the best procedure code for this?

Comments 0

Views 54

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