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.
Billing Injectables to Skilled Nursing Facility

MAR 05, 2021 in Coding Competency, Ask the Expert, Retina

Q: Since Medicare states it will not reimburse for injected drugs while the patient is in a skilled nursing facility (SNF), do we bill the full amount to the facility?

Comments 0

Views 95

Patient Fees During Global Period

MAR 05, 2021 in Ask the Expert, Exams, Coding Competency

Q: For exams, tests or surgeries that are submitted to the payer during the global period, does the patient have out-of-pocket expenses associated?

Comments 0

Views 155

Academy Series of Free Webinars on Payments and Reimbursements

OCT 09, 2020 in Testing Services, Coding Updates, Coding Competency, Retina

Register today for two LIVE Zoom webinars on Dec. 8 for the CMS Final Fee Schedule rule and on Dec. 15 for the 2021 MIPS Reporting.

Comments 0

Views 857

ICD-10 code for headaches not based examination

SEP 20, 2020 in Ask the Expert, ICD-10, Coding Competency

We have a patient who complains of headaches; however, the physician is not classifying it as a migraine based on examination. What ICD-10 code should we use?

Comments 0

Views 775

ABN Usage for Dual-Eligible Patients

SEP 20, 2020 in ICD-10, Ask the Expert, Coding Competency

We have a patient who qualifies for Qualified Medicare Beneficiary (QMB). Are we able to use an Advance Beneficiary Notice (ABN) for a lesion removal?

Comments 0

Views 201

Billing Multiple Retina Testing Services Same Day

SEP 10, 2020 in Coding Competency, Coding Updates, Testing Services, Retina

Although medical necessity may require multiple tests in a session, billing may not allow for all to be submitted. Always confirm if there is a bundling edit in place by the payer.

Comments 0

Views 554

Billing Two YAG Lasers Same Session

JUN 24, 2020 in Coding Competency, Ask the Expert

Can you bill both a YAG iridotomy and a YAG capsulotomy on the same eye, when performed in the same session?

Comments 0

Views 229

Precollection of Payment

JUN 24, 2020 in Ask the Expert, Coding Competency

Are practices allowed to request collection of co-payment prior to an appointment?

Comments 0

Views 105

Postoperative Exams When Self Pay

JUN 10, 2019 in Exams, Coding Competency, Ask the Expert

Question: When a self-paying patient has medically necessary surgery, are postoperative exams included or separately billed?

Comments 0

Views 237

Dedicated Procedure Room Requirements

JUN 10, 2019 in Coding Competency, Ask the Expert

Question: What are the requirements for having a dedicated procedure room in our practice?

Comments 0

Views 345

Billing for Patients with Dual-Eligibility Status

MAY 08, 2018 in Coding Competency, Coding Updates

When patients have Medicare and Medicaid, or dual-eligibility status, they often receive some type of assistance with their Medicare premium payments based on income. Your remittance advice from payers will indicate when and if the patient owes anything out of pocket.

Comments 0

Views 306

Academy Announces New Retina-Specific OCS Exam

FEB 01, 2018 in Coding Updates, Coding Competency

Effective April 2, the Academy will administer the Ophthalmic Coding Specialist examination and offer a new retina-specific version.

Comments 0

Views 1495

Exams for Family Members

APR 22, 2016 in Ask the Expert, Coding Competency, Exams

Question: Our physician’s husband had cataract surgery performed by another surgeon, but she will manage her husband’s postoperative care. Which modifier(s) do we append for payment of the global period?

Comments 0

Views 508

CMS to Announce Zip Codes Eligible for 2016 Shortage-Area Bonuses

DEC 06, 2015 in Coding Competency, Regulatory News

This December, CMS will notify each Medicare Administrative Contractor of the applicable 2016 zip codes that qualify as a Health Professional Shortage Area. Claims submitted Jan. 1 to Dec. 31, 2016 for services in an shortage area will be eligible for a bonus. The bonus appl…

Comments 0

Views 192

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