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 621 results
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Unbundling 92250 with 92133 or 92134

SEP 09, 2021 in Testing Services, Glaucoma, Retina, Ask the Expert

Our practice received an audit request for 10 records. They are all times when we’ve unbundled CPT code 92133 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve or 92134 retina from 922…

Comments 0

Views 360

We fit keratoconus lenses and are questioning coverage. Does Medicare cover the actual lenses?

SEP 08, 2021 in Testing Services, Ask the Expert

We fit keratoconus lenses and are questioning coverage. Does Medicare cover the actual lenses?

Comments 0

Views 38

Due to a dense cataract, the IOL measurement was taken on CPT codes 92136 and then 76519. Can I bill both tests?

SEP 08, 2021 in Ask the Expert, Testing Services, Cataract/Anterior Segment

Due to a dense cataract, the IOL measurement was taken on CPT codes 92136 and then 76519. Can I bill both tests?

Comments 0

Views 55

One of our patients is currently in an assisted living facility. Should we treat this as a skilled nursing facility when it comes to billing?

SEP 08, 2021 in Testing Services, Ask the Expert

One of our patients is currently in an assisted living facility. Should we treat this as a skilled nursing facility when it comes to billing?

Comments 0

Views 29

Under Medicare's multiple procedure payment reduction, what will the payment be for these services?

SEP 08, 2021 in Testing Services, Ask the Expert, Glaucoma

Under Medicare's multiple procedure payment reduction, what will the payment be for these services? The physician performed an exam and gonioscopy. Following the exam, pachymetry, RNFL and visual field were ordered.

Comments 0

Views 35

When performing external ocular photography of patients prior to upper lid blepharoplasties, must the picture itself be tagged by patient name, chart number and date of service?

SEP 08, 2021 in Testing Services, Oculofacial, Ask the Expert

When performing external ocular photography of patients prior to upper lid blepharoplasties, must the picture itself be tagged by patient name, chart number and date of service?

Comments 0

Views 6

Is scleral depression a requirement for CPT code 92201

AUG 17, 2021 in Testing Services, Retina, Ask the Expert

Is scleral depression a requirement for CPT code 92201?

Comments 0

Views 74

CPT code 92134 covered for a diagnosis other than wet macular degeneration

AUG 17, 2021 in Ask the Expert, Testing Services, Retina

How often is CPT code 92134 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina covered for a diagnosis other than wet macular degeneration?

Comments 0

Views 124

Payers Do Not Have Published Policy on Particular Test

AUG 17, 2021 in Ask the Expert, Testing Services

What if Medicare and/or a commercial payer doesn’t have a published policy on a particular test? Do I just guess at coverage, or is a medically reasonable diagnosis a guarantee of coverage?

Comments 0

Views 56

Level of Supervision for Tests for Medicare

AUG 05, 2021 in Testing Services, Ask the Expert

Where do I find the level of supervision for each test for Medicare?

Comments 0

Views 122

Level of Supervision for Tests

AUG 05, 2021 in Ask the Expert, Testing Services

What if the commercial plan doesn’t publish the level of supervision for tests?

Comments 0

Views 41

Documentation and Test Dates

AUG 05, 2021 in Testing Services, Ask the Expert

Our ophthalmologist doesn’t not always document the interpretation and report the same day the test is performed. Should we be billing the technical component the day the test is performed and the professional component on the day of the interpretation?

Comments 0

Views 109

Documentation for Test in Separate Note

AUG 05, 2021 in Testing Services, Ask the Expert

What if the documentation ordering the test is in another exam note and not the one requested by the auditor?

Comments 0

Views 53

Coding Top 10: Unbundling 92250 with 92133 or 92134, Denials for testing services with code N433, Determining the correct modifier

JUL 22, 2021 in ICD-10, Ask the Expert, Coding Top 10, Coding Updates

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

Comments 0

Views 891

Determining the correct modifier

JUL 21, 2021 in Modifiers, Ask the Expert

We need help determining the correct modifier to use on a claim.

Comments 0

Views 219

Commercial payer denying claims for Avastin

JUL 21, 2021 in Ask the Expert, Retina

We are having issues with a commercial payer denying claims for Avastin? They are denying these claims stating that the National Drug Code (NDC) number should be 11 digits not 10. Any information is helpful.

Comments 0

Views 109

Billing when Avastin is performed bilaterally

JUL 21, 2021 in Ask the Expert, Retina

One of the providers asked if Avastin could be performed bilaterally. The billing department gave the okay. The code 67028 has medically unlikely edit (MUE ) of 1 and Medicare Physician Fee Schedule (MPFS) indicator of 1 while J7999 has MUE of 2 and MPFS indicator of 9.

Comments 0

Views 100

We injected a patient with clindaymcin. When I searched, all I found was an S code. Can you confirm this is true?

JUL 21, 2021 in Retina, Ask the Expert

We injected a patient with clindaymcin. When I searched, all I found was an S code. Can you confirm this is true?

Comments 0

Views 48

Denials for testing services with code N433

JUL 21, 2021 in Testing Services, Ask the Expert

We are getting a lot of denials for testing services with code N433. We are wondering what we are doing wrong to get this denial code.

Comments 0

Views 105

Is a Schirmer’s test is billable?

JUL 21, 2021 in Testing Services, Ask the Expert

Can you tell me if a Schirmer’s test is billable?

Comments 0

Views 90

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