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.
1-20 of 842 results
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Ready to Use JZ Modifier by July 1?

MAY 31, 2023 in Glaucoma, Coding Competency, Retina, Ask the Expert, Oculofacial

The Academy and AAOE Fact Sheet: JW and JZ Modifiers provides ophthalmic-specific guidance for the implementation of JZ modifier by July 1.

Comments 0

Views 1222

How to Bill Wastage for Botox and Two Patients

MAY 30, 2023 in Ask the Expert, Oculofacial, Modifiers, CPT

We have two Medicare patients who received medical botox the same day from the same vial. One received 50 units and the other 25, leaving 25 units of wastage. What is the best way to report this?

Comments 0

Views 198

Virtual Visual Fields

MAY 08, 2023 in Coding Competency, Ask the Expert, Testing Services

Is virtual visual field testing billable?

Comments 0

Views 102

Dilating Drops and Medical Decision-Making

MAY 08, 2023 in Coding Competency, Ask the Expert, Exams

Does documenting that the patient was counseled regarding the risks and possible side effects of dilating drops count toward the prescription counseling requirement of medical decision-making (MDM)?

Comments 0

Views 80

YAG Laser When Performed in Global Period

MAY 08, 2023 in Cataract/Anterior Segment, Modifiers, Ask the Expert

Which is the correct modifier to use for a YAG laser capsulotomy, CPT code 66821, performed during the post-op period of the initial cataract surgery, 78 or 79?

Comments 0

Views 116

Goniotomy and Cataract Surgery

MAY 08, 2023 in Ask the Expert, Glaucoma, Coding Competency

Can you bill a goniotomy, CPT 65820, and standard cataract surgery, CPT 66984, together?

Comments 0

Views 221

Is dilation required?

MAY 08, 2023 in Exams, Ask the Expert, Coding Competency

For Eye visit codes, if the physician documents 12 exam elements on an established patient, but doesn't dilate, do we bill a 92012 or 92014?

Comments 0

Views 122

Internal Co-Management

MAY 08, 2023 in Modifiers, Ask the Expert, Coding Competency

When the comanaging optometrist is employed in our practice, do we bill insurance for co-management? Same practice, same chart.

Comments 0

Views 35

National Correct Coding Initiative Edits

MAY 08, 2023 in Modifiers, Coding Competency, Ask the Expert

It was mentioned during Codequest that when CPT codes are bundled, they will have a National Correct Coding Initiative (NCCI )indicator of 1 or 0. Where are these indicators located?

Comments 0

Views 77

Follow-Up Exam Prior To Cataract Surgery

MAY 08, 2023 in Exams, Coding Competency, Cataract/Anterior Segment, Ask the Expert

If a cataract patient comes in for pre-surgical testing and discussion of the cataract surgery can the physician charge an evaluation and management (E/M) code? The patient has already had a comprehensive eye exam to determine the need for the surgery.

Comments 0

Views 78

New Orthoptic Training Codes

MAY 08, 2023 in Pediatric/Strabismus, Ask the Expert

Can we use the 2023 revised orthoptic training CPT code 92065, Orthoptic training, performed by a physician or other qualified health care professional when the orthoptist sees the patient?

Comments 0

Views 19

Intravitreal Injection for Geographic Atrophy

MAY 05, 2023 in Retina, Ask the Expert

How should we code for an intravitreal injection with a new drug for geographic atrophy (GA) (e.g., Syfovre), and are there any initial challenges with payer coverage?

Comments 0

Views 184

How Often Should We Confirm Prior Authorization Requirements?

APR 10, 2023 in Ask the Expert, Coding Competency, Retina

In January, prior authorization was not required for a patient's intravitreal injection, and the claim was paid. In February, the claim was denied as requiring authorization. The payer representatives are telling us we need to check monthly as their plan benefits could chang…

Comments 0

Views 176

Performing Confrontational Visual Fields

APR 10, 2023 in E/M, Coding Competency, Ask the Expert, Exams

Is it necessary to do confrontational visual fields when coding any level of an exam?

Comments 0

Views 87

Premium Lens Fees and Co-Management

APR 10, 2023 in Cataract/Anterior Segment, Ask the Expert

Our practice co-manages with an ophthalmologist in another town who does not do surgery. Is it customary to give the doctor in the co-managing practice a percentage of the premium lens when they send the patients to us?

Comments 0

Views 248

Moderate Level Visit for Oculofacial Surgery

APR 10, 2023 in E/M, Exams, Ask the Expert, Oculofacial

Are we able to bill a level 4 evaluation and management E/M (99214) or a comprehensive Eye visit code (92014) for patients that schedule oculofacial surgeries?

Comments 0

Views 29

Correct Number of Strabismus Post-op visits

APR 10, 2023 in Exams, Pediatric/Strabismus, CPT, Coding Competency, Ask the Expert

How many post-op visits does the Centers for Medicare & Medicaid Services (CMS) include in the value of the global surgical package for strabismus surgery?

Comments 0

Views 12

Glaucoma Problems Addressed at the Encounter

APR 10, 2023 in Exams, Ask the Expert, E/M, Coding Competency, Glaucoma

I was told if patients have two different stages of glaucoma — moderate in one eye, severe in the other eye — this counts as two problems. Is that correct?

Comments 0

Views 36

Modifier Usage During Global Period

APR 10, 2023 in Modifiers, Ask the Expert

We have a patient in the global period for surgery on the right eye and we performed a laser (SLT) on the left eye. Do we append modifier 24 to the visit or the laser?

Comments 0

Views 101

Billing for Xipere

APR 10, 2023 in Ask the Expert, ICD-10, Retina

Will you provide guidance on billing Xipere? Are other ophthalmic practices experiencing billing issues and/or denials?

Comments 0

Views 384

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