Researching codes can take time. The Academy provides easy access to the tools physicians and staff need to submit a claim successfully and save time.
Two important tips:
- The No. 1 rule in coding is identifying the payer. Whether commercial or federal, each payer can and does have its own rules.
- The No. 2 rule is don't apply one payer’s rules, or perceived rules, to all other payers
Biometry Fact Sheet
Details billing guidelines and differences among payers [PDF]
Clinical Laboratory Improvement Amendments (CLIA) Application for Certification
Correct Coding Initiative Edits
Version 27.1 effective April 1, 2021. There are no new edits impacting ophthalmology.
Edits Impacting Ophthalmology [PDF]
Guidelines for Billing Medicare Beneficiaries When Using the Femtosecond Laser
A joint position paper from the Academy and the American Society for Cataract and Refractive Surgery on using the femtosecond laser for cataract surgery
Find decision trees, quick reference guides and key features of new CCI edits effective Oct 1. at www.aao.org/icd10.
MIGS Fact Sheets
Whether inserting in conjunction with cataract surgery, or as a stand-alone procedure, repositioning, trimming or removing, proper coding is detailed in these documents.
Optiwave Refractive Analysis (ORA)
Appropriate Billing for Optiwave Refractive Analysis (ORA) Performed During Cataract Surgery (PDF)
Preauthorization Check List
Medicare Advantage Plans, Commercial insurance and Medicaid plans often require preauthorization of exams, tests and surgeries. Make sure you are capturing all the necessary components by using this checklist [PDF]
Premium IOLs – A Legal and Ethical Guide to Billing Medicare Beneficiaries
Check your patient out-of-pocket expense document to assure compliance. See the Oct. 2018 EyeNet Savvy Coder for details.
National Provider Identification locators: NPI Look-up; NPI Provider Search
Refraction Fact Sheet
Coverage guidelines for billing [PDF] refraction
Telemedicine Fact Sheet
View the Coding for Telemedicine Fact Sheet [PDF]
VF-8R Visual Functioning Questionnaire
View the Pre-Cataract Surgery VF-8R Patient Questionnaire [PDF]
Medicare Part B Essentials
Advance Beneficiary Notice
Note: Effective January 1, 2021 CMS requires all practices to use an updated version of form CMS-R-131, known as the Advance Beneficiary Notice or ABN. New expiration date 06/30/2023.
Related article: "How to Use the ABN, 2020 Edition".
Items and Services Not Covered Under Medicare
CMS document that supports your communication to the patient on non-covered exam, tests and surgeries.
Local Coverage Determination Policies
To help you successfully meet the requirements put forth by your Medicare Administrative Contractor, the Academy has provided the applicable local coverage determination policies for each U.S. state and some territories.
Medicare Carrier Jurisdiction and Website Addresses
View the medicare carrier web site addresses [PDF] updated February 2018.
Postoperative Visit Reporting
CMS is tracking number of postop visits actually reported on several surgical codes from a select set of practices. Visit www.aao.org/99024 for details.
Learn about subspecialty taxonomy codes and how to implement.