Coding: Medicare Considerations of Compounded Drugs

Billing differs for FDA-approved and compounded drugs. Compounded medications can be beneficial in certain circumstances. This article discusses how they can be billed in a retina practice. How should a clinic bill for compounded medicines? Are compounding pharmacies regulated?

Read More

Coding & Reimbursement: Part C Medicare vs Traditional Medicare

We can expect enrollment in Medicare Part C, or Medicare Advantage (MA), to continue its two-decade long trend of growth. According to the Kaiser Family Foundation (KFF), MA enrollment in 2023 was 30.8 million or 51% of eligible beneficiaries.1 The Congressional Budget Office estimates that enrollment will rise to about 61% of eligible beneficiaries by…

Read More

Coding: Should You Perform More Laser Trabeculoplasty?

There are far more eligible patients than those who are receiving therapy. Not infrequently, an ophthalmologist or optometrist receives a critical letter that informs the recipient that their utilization rate for a procedure is higher than the norm. The letter implies that the procedure is performed too frequently and perhaps unnecessarily. Unfortunately, there is no…

Read More

Coding & Reimbursement: The ASC and Unlisted Procedure Codes

“All good things must come to an end,” and I’m afraid my authorship of this column is another one of those things. After more than 20 years writing for Ophthalmology Management’s readers, I will be handing this column off to another veteran of the coding and reimbursement struggle — my colleague Brandy Sperry. I have…

Read More

Coding: Cataract Documentation

As the most frequently performed ophthalmic surgeries, cataract procedures continue to receive payer scrutiny. Between the Targeted Probe and Educate audits, the 2022 Supplemental Medicare Review Contractor (SMRC) audit conducted by Noridian, the 2022 Medicare Fee-for-Service Supplemental Improper payment data, and attention from non-Medicare payers, many cataract surgeons are reviewing their charts and claims and, where…

Read More

Coding: Medicare Coverage of MIGS

A recent policy reversal for MIGS coverage by several Medicare Administrative Contractors raised questions about what’s next. In 2023, 5 Medicare Administrative Contractors (MACs) — WPS, CGS, NGS, Noridian, and Palmetto — developed new, controversial and restrictive local coverage determination (LCD) policies for minimally invasive glaucoma surgery (MIGS). In December, they announced they “… will…

Read More

Coding Q&A: Part C Medicare vs Traditional Medicare

Practice managers must understand the implications of the shifting landscape. Medicare Part C, or Medicare Advantage (MA), refers to health insurance plans from private companies that have been approved by Medicare. The MA market features a complex and changing landscape of competition for eligible beneficiaries. Enrollment in MA plans has steadily increased due to the…

Read More

Coding: Non-Covered Services

Many practices assume that services without regular CPT codes are automatically non-covered and payable by the patient. At the same time, codes with allowed amounts listed in the Medicare Physician Fee Schedule (MPFS) are presumed to be covered and paid by Medicare.  However, although Category III codes (“T-codes”) and miscellaneous CPT codes (codes ending in…

Read More

Coding Q&A: What’s New in Retina Coding for 2024

Revised E/M code descriptions and a new CPT code for suprachoroidal injections are among the changes. The American Medical Association recently released the Current Procedural Terminology (CPT) code set for 2024. As usual, there are important coding changes, as well as changes to Medicare reimbursement, that retina practices need to be aware of in the…

Read More