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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Sept 2023 – Special Edition: Retina Coding Summer Symposium Top 10

SEP 12, 2023 in E/M, Coding Top 10, Retina, Coding Competency, Modifiers

This special edition of the Coding Top 10 includes questions from the 2023 Retina Coding Summer Symposium presented July 25 and includes a couple video highlights from the session. If you missed the live event, you can purchase the recording through Nov. 20.

Comments 0

Views 288

Modifier for Injection Performed During Global Period

SEP 12, 2023 in Ask the Expert, Coding Competency, Modifiers, Retina

During the global period where the injection is performed for a diagnosis that differs from the surgery, is modifier -58 or -79 appropriate?

Comments 0

Views 126

Decision to Change Drug Used for Intravitreal Injection

SEP 12, 2023 in E/M, Retina, Ask the Expert, Coding Competency

If we bill an office visit when the retinal specialist makes the decision to change the drug used for intravitreal injection treatment, would that be an evaluation and management (E/M) 99213 or 99214 when changing the drug?

Comments 0

Views 85

Drug Reimbursement for Patient with Inpatient Status

SEP 12, 2023 in Coding Competency, Ask the Expert, Retina

If a patient has inpatient status and is brought to the clinic for evaluation and treatment, will the drug be reimbursed when filed with place of service 21?

Comments 0

Views 9

Reporting a Not Otherwise Classified Drug Code

SEP 12, 2023 in Retina, Ask the Expert, Coding Competency

Where would we place the additional information for a drug reported with a NOC HCPCS code on the claim form, or does it matter?

Comments 0

Views 26

Fundamentals of Coding Top 10 - Special Edition

AUG 14, 2023 in Oculofacial, Coding Top 10, Telemedicine, Cataract/Anterior Segment, E/M, Coding Competency, Retina, Testing Services, Diabetes, Modifiers, Exams, CPT

This month's special edition Coding Top 10 includes questions from the 2023 Fundamentals of Ophthalmic Coding Course presented on June 27 in collaboration with the Academy’s Young Ophthalmologist (YO) Committee.

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Views 727

Congratulations to OCS and OCSR Designees

AUG 08, 2023 in Modifiers, Cornea, Pediatric/Strabismus, Cataract/Anterior Segment, Coding Updates, CPT, Exams, Glaucoma, Testing Services, ICD-10, Oculofacial, Coding Competency, Retina

Here is an updated list of individuals who have passed the Ophthalmic Coding Specialist and/or Ophthalmic Coding Specialist Retina exams in 2023.

Comments 0

Views 711

Documenting Visually Significant Cataract

AUG 04, 2023 in Exams, Coding Competency, Ask the Expert, Cataract/Anterior Segment

What is the recommended documentation for a visually significant cataract that requires surgery? Is a manifest refraction required for every cataract surgery or will a glare test suffice?

Comments 0

Views 120

Defining Major Surgery in Ophthalmology

AUG 04, 2023 in E/M, Ask the Expert, Coding Competency

Can you please clarify again what defines a major surgery in ophthalmology?

Comments 0

Views 86

Interpreting Remote Fundus Photography

AUG 04, 2023 in Retina, Testing Services, Telemedicine, Ask the Expert, Diabetes, Coding Competency

Can ophthalmologists work with internal medicine physicians in caring for diabetic patients where internal medicine provides fundus photography (CPT code 92250 -TC) and the ophthalmologist provides the interpretation (CPT code 92250 –26)?

Comments 0

Views 66

Unbundling Ptosis Repair and Blepharoplasty

AUG 04, 2023 in Oculofacial, Modifiers, Ask the Expert, Coding Competency

If the surgeon performs a bilateral repair of blepharoptosis (CPT code 67904) and bilateral upper lid blepharoplasty (CPT code 15823), would we add modifier –59 to unbundle?

Comments 0

Views 98

YAG Laser Capsulotomy in the Global Period

AUG 04, 2023 in Cataract/Anterior Segment, Coding Competency, Ask the Expert

If a YAG laser capsulotomy is performed one month after cataract surgery in the same eye, is it reimbursable?

Comments 0

Views 86

Units Billed for Trichiasis

AUG 04, 2023 in Ask the Expert, Coding Competency

How many units can be billed and what modifiers should be used when billing for the correction of trichiasis; epilation, by forceps (67820) on multiple lids?

Comments 0

Views 116

Bilateral Macular Degeneration with Single-Eye Treatment

AUG 04, 2023 in Retina, Ask the Expert, Coding Competency

Our retina specialist sees a patient for wet macular degeneration OU H35.3231 and only injects the right eye. Do we link the bilateral ICD-10 to the injection code and drug even though we are only treating one eye?

Comments 0

Views 45

Office Visit with Corneal Foreign Body Removal

AUG 04, 2023 in Coding Competency, Modifiers, Ask the Expert, Exams

Can you bill an office visit with a corneal foreign body removal?

Comments 0

Views 105

Satisfying Delegated Testing Order Requirements

AUG 04, 2023 in Coding Competency, Testing Services, Ask the Expert

If a new patient is being seen, can I have my scribe note in the chart that, “Dr X orders an OCT macula due to hypertension,” and will that satisfy the order criteria?

Comments 0

Views 71

Appropriate Diagnosis for Fundus Photography

AUG 04, 2023 in Coding Competency, Ask the Expert, Testing Services

When billing fundus photos for a diabetic eye exam with no retinopathy, is ICD –10 code Z13.1 Encounter for screening for diabetes mellitus an appropriate diagnosis?

Comments 0

Views 149

Coding Top 10 - July 2023

JUL 20, 2023 in Retina, Glaucoma, CPT, Coding Top 10, Coding Competency, Cataract/Anterior Segment, Pediatric/Strabismus, Exams, Modifiers, E/M

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

Comments 0

Views 586

Do We Use Modifier -JW with Residual Eylea?

JUL 20, 2023 in Modifiers, Retina, Coding Competency, Ask the Expert

Our ophthalmologist reports that if we have Eylea remaining in the syringe after an injection, we should bill the waste with modifier -JW. Is this correct?

Comments 0

Views 96

Covered Diagnosis for Botox Injections for Migraine

JUL 19, 2023 in ICD-10, Coding Competency, Ask the Expert

We submitted a claim to Medicare for Botox injections for a patient who has migraines. The diagnosis linked was G43.919 migraines, unspecified intractable without status migraines. Medicare denied it, stating it was a noncovered service because this is not deemed a medical n…

Comments 0

Views 49

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