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 116 results
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CMS Releases Comparative Billing Reports on Cataract surgery

SEP 22, 2022 in Cataract/Anterior Segment, Ask the Expert, Coding Competency

Are you an outlier for cataract surgery and related services? Facilitated by the contractor RELI group, the Centers for Medicare & Medicaid Services has issued a comparative billing report (CBR) on Medicare Part B claims from Jan. 1 to Dec. 31, 2019 for three key metrics.

Comments 0

Views 28

Coding Top 10 - September 2022

SEP 20, 2022 in Pediatric/Strabismus, Ask the Expert, Oculofacial, Exams, Coding Top 10, Cataract/Anterior Segment, Retina, Testing Services, Trauma Coding, Coding Competency, 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 127

Coding for Ruptured Capsule Repair

SEP 20, 2022 in Coding Competency, Cataract/Anterior Segment, Ask the Expert

During cataract surgery, the patient's capsule ruptured due to weak zonules. The IOL could not be implanted. Can you advise us of the code for this?

Comments 0

Views 20

Ophthalmic Biometry

SEP 20, 2022 in Coding Competency, Modifiers, Testing Services, Cataract/Anterior Segment, Ask the Expert

We filed 92136-TC and 92136-26 and identified which eye. I have filed several disputes, and those also have been denied. The payer told me the wrong modifier is being used.

Comments 0

Views 22

Interim Exam Between Cataract Surgeries

AUG 17, 2022 in Ask the Expert, Cataract/Anterior Segment

Can I bill for an interim exam between cataract surgeries?

Comments 0

Views 233

Coding Top 10 - August 2022

AUG 16, 2022 in Coding Top 10, ICD-10, Modifiers, Cataract/Anterior Segment, CPT, Retina, Pediatric/Strabismus, Telemedicine, Cornea, Testing Services, Trauma Coding, Exams, Coding Competency, Ask the Expert, 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 721

Attention Florida: Pay Attention to Cataract Surgery Documentation

AUG 03, 2022 in Cataract/Anterior Segment, Ask the Expert, Coding Updates, Coding Competency

Now is the time to review the current documentation protocol to ensure that missed documentation does not result in lost practice revenues. Aetna Medicare Advantage (including dual Medicare-Medicaid) members in Florida will require prior authorization for outpatient procedur…

Comments 0

Views 325

Targeted Probe and Educate (TPE) Failures: Don’t Miss the Deadline

JUL 19, 2022 in Cataract/Anterior Segment, Coding Competency, Ask the Expert

Targeted Probe and Educate (TPE) audits are used to increase accuracy and provide education in specific regions. Medicare administrative contractors (MACs) use data analysis to identify physicians and suppliers who have high claim error rates or unusual billing practices, as…

Comments 0

Views 214

Coding Top 10 - July 2022

JUL 19, 2022 in Cataract/Anterior Segment, Glaucoma, Testing Services, Coding Top 10, ICD-10, Diabetes, CPT, Exams, Modifiers, Retina, Ask the Expert, Coding Competency

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

Release of Posterior Synechiae With Complex Cataract Surgery

JUL 18, 2022 in Coding Top 10, Cataract/Anterior Segment, Ask the Expert

What CPT would we use for complex cataract with release of posterior synechiae?

Comments 0

Views 91

Iris Angiography

JUL 15, 2022 in Cataract/Anterior Segment, Coding Top 10, Ask the Expert

In treating a patient with rubeosis, is there a procedure code for iris angiography?

Comments 0

Views 32

Georgia Ophthalmologists: Prepare for Humana Cataract Surgery and YAG Laser Prior Authorization on Aug. 1

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

Ophthalmologists in Georgia should prepare for Humana’s Medicare Advantage plans to begin implementing a prior authorization requirement on Aug. 1 for cataract and YAG capsulotomy procedures.

Comments 0

Views 734

Noridian Reports Cataract Documentation Failure Rates

JUN 07, 2022 in Cataract/Anterior Segment, Coding Competency, Ask the Expert

Cataract surgery continues to be one of the most common surgeries performed, and because of this, remains a top audit target for all payers.

Comments 0

Views 1137

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.

Comments 0

Views 1105

Billing for Laser-Assisted Cataract Surgery

MAY 31, 2022 in Coding Top 10, Ask the Expert, Cataract/Anterior Segment

I have a patient who requests to have laser assisted cataract surgery but has little to no astigmatism and an IOL that does not meet specialty lens parameters. My understanding is that Medicare does not allow the patient to pay for this out of pocket. Is this true?

Comments 0

Views 137

Testing Before Surgery

MAY 31, 2022 in Testing Services, Coding Top 10, Cataract/Anterior Segment, Ask the Expert

Our practice standard is to obtain a macular OCT on patients prior to undergoing cataract surgery. This allows the surgeon to pick up preexisting macular pathology so that patients can be counseled appropriately on visual outcomes following surgery. Some of these OCTs do not…

Comments 0

Views 114

Discontinued Cataract/MIGS surgery

MAY 24, 2022 in Coding Top 10, Cataract/Anterior Segment, Ask the Expert, Modifiers

Our physician was performing a cataract extraction with IOL and iStent (CPT 66991). they were able to perform the cataract extraction and placement of the IOL but were unable to insert the iStent into the canal after several attempts. They stopped at that point of the proced…

Comments 0

Views 105

Billing RxSight IOL

MAY 24, 2022 in Ask the Expert, Cataract/Anterior Segment, Coding Top 10

How would we bill a patient for the light adjustable lens?

Comments 0

Views 67

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.

Comments 0

Views 1402

New Light Adjustable IOL Coding and Billing

APR 22, 2022 in Cataract/Anterior Segment, Coding Top 10, Coding Competency, Ask the Expert

Can you offer any insight on the most appropriate way to bill the light adjustable IOL, RxSight? Would V2787 be an appropriate code since this seems to function most like a toric lens?

Comments 0

Views 340

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