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.
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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 103

Commercial Denial of -GA Modifier

JAN 20, 2023 in CPT, Coding Competency, Testing Services, Ask the Expert

We recently billed an OCT with -GA modifier, and it was denied by Blue Care Network Advantage plans. They state the -GA modifier is not needed, and we should delete it.

Comments 0

Views 15

Canceled Cataract Surgery for Chalazion Removal

JAN 19, 2023 in CPT, Ask the Expert, Oculofacial

A patient was scheduled for cataract surgery but presented to the ambulatory surgery center (ASC) on the scheduled day of surgery with a large infected chalazion. The surgeon canceled the cataract surgery and removed the chalazion instead. How do we properly code this proced…

Comments 0

Views 10

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 11

When Should We Unbundle?

JAN 19, 2023 in Modifiers, Coding Competency, Ask the Expert, CPT

When is it appropriate to unbundle CPT codes 67113 and 66982 or 66984?

Comments 0

Views 14

Additional Paperwork

JAN 19, 2023 in Coding Competency, Ask the Expert, Exams

Is there a reportable CPT code when our physician completes additional paperwork for the patient, such as the federal Family Medical Leave Act (FMLA)?

Comments 0

Views 4

E/M Guideline Changes

JAN 19, 2023 in E/M, Ask the Expert, Exams

It is December 2022, and our office just realized evaluation and management (E/M) office coding no longer requires specific history or exam components. We are only using Eye Visit codes. Now we want to use the higher E/M level 4 and 5 codes. Where should we start?

Comments 0

Views 26

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 12

MIGS Bio Stent Billing

JAN 19, 2023 in Ask the Expert, Glaucoma, CPT

The surgeon would like to insert a MIGS bio stent, internal approach, into the suprachoroidal space. What is the correct coding for a standalone procedure and when performed with cataract surgery?

Comments 0

Views 13

Drug and Injection Recoupment

JAN 18, 2023 in Ask the Expert, CPT, Retina

A patient needed Eylea for wet AMD, and we were not able to get prior authorization. The payer did not cover the drug and is recouping the payment for 67028. Is a payer allowed to recoup both the drug and the procedure when prior authorization is only required for the drug?…

Comments 0

Views 16

Contraindication for Dilation

JAN 18, 2023 in Exams, Ask the Expert, CPT

When considering billing a comprehensive Eye Visit code (92004 or 92014) does documenting the patient’s refusal to be dilated count as a contraindication?

Comments 0

Views 19

Introducing Modifier -JZ

JAN 18, 2023 in Coding Competency, Ask the Expert, Modifiers, Retina

The Centers for Medicare & Medicaid Services introduced a new modifier to indicate when no waste is discarded from a single-dose vial drug and has published FAQs as guidance.

Comments 0

Views 289

Coding Competency Challenge

DEC 21, 2022 in Exams, Testing Services, Modifiers, Coding Competency, Ask the Expert

Challenge accepted. Take this short quiz to start the process of discovering coding areas that need improvement. The Academy provides trusted coding and reimbursement expertise through a variety of resources.

Comments 0

Views 331

Proper Coding Begins With Commercial Payer Policies, Part 2

DEC 21, 2022 in Coding Competency, Ask the Expert

Staying abreast of payer policy changes can help avert denials and keep you on the financial fast track.

Comments 0

Views 18

Proper Coding Begins With Commercial Payer Policies, Part 1

DEC 21, 2022 in Coding Competency, Ask the Expert

Follow these tips to locate commercial payer guidelines and ensure you are following the fastest route to proper reimbursement.

Comments 0

Views 183

3 Reasons to Confirm Designated Taxonomy Codes Are Correct

DEC 05, 2022 in Ask the Expert, Coding Competency

Three reasons to confirm designated taxonomy codes are correct.

Comments 0

Views 118

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 302

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 452

Experimental Denial for Amniotic Membrane Tissue

DEC 01, 2022 in Ask the Expert, Coding Competency

A local insurance carrier is denying insertion of an amniotic membrane tissue, stating CPT 65778 is experimental and not covered. How do we get paid?

Comments 0

Views 40

Post Cataract Glasses Prescription

DEC 01, 2022 in Coding Competency, Ask the Expert

What is required on a prescription for glasses after cataract surgery for traditional Medicare to pay?

Comments 0

Views 48

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