How to Document and Code Lesion Removal – Review of Ophthalmology

The number, histology, location, removal method – a host of factors can come into play when billing these procedures. This article addresses the following questions: Is there a method to determine the best CPT code for lesion removals? Do lesion removal codes have a global period, and may we file for an office visit on…

Read More

A rare test for glaucoma needn’t be provocative – Ophthalmology Management

These glaucoma tests are rare, but questions still arise. In case you have some, here’s help. This article addresses the following questions: What is provocative testing for glaucoma? Who performs these tests? How do we code for this? What does Medicare allow for 92140? What documentation is required in the medical record to support claims…

Read More

When Your Medicare Cup Runneth Over – Review of Ophthalmology

The Centers for Medicare & Medicaid Services defines an overpayment as money received, usually from a third party payer, based on a claim for reimbursement that should not have been paid. An overpayment may be all or part of the payment received. It may be the result of an unintended mistake or caused by intentional…

Read More

What’s New in 2016: Fees, Codes and More – Review of Ophthalmology

There are no new ICD-10 codes at this time, but there are plenty of other changes to codes and reimbursements to know about. This article addresses the following questions: Is the 2016 Medicare Physician Fee Schedule favorable for ophthalmology? What type of relative value unit changes occurred on January 1, 2016? What is the target…

Read More

Reading the glaucoma reimbursement tea leaves – Ophthalmology Management

This month we will review trends in glaucoma reimbursement — past and future — in the larger context of eye care. In the United States, the most common eye diseases are age-related macular degeneration, cataract, glaucoma and diabetic retinopathy. As baby boomers age, their demands for healthcare and eye care will grow. Some ocular conditions…

Read More

2016 bulletin on fee schedules, codes – Ophthalmology Management

The new year, of course, brings changes to the coding landscape. This month, we will look at changes to the Medicare fee schedules, as well as coding changes for 2016. This article addresses the following questions: What happened with the Medicare Physician Fee Schedule as of Jan. 1? What about ambulatory surgery center facility fees…

Read More

Risk Adjustment Audits For Medicare Part C – Review of Ophthalmology

Knowing what to expect from a Risk Adjustment Data Validation audit will help to prevent easily avoidable errors. This article addresses the following questions: Does Medicare Part C function in the same manner as Medicare Part B? Is beneficiary enrollment in Medicare Advantage plans growing? Who pays private insurance companies to manage Part C plans?…

Read More

Overpaid? Send it back, and quickly – Ophthalmology Management

Recent actions by payers and law enforcement have changed the landscape regarding refunding overpayments — and not in ways that favor practices. Importantly, two recent precedents make it clear that you no longer can “investigate whether the overpayment is real” before determining that the 60-day window is implicated; it begins immediately. Here is an update…

Read More

ICD-10 is here – Ophthalmic Professional

After a few years’ delay, ICD-10 arrived on Oct. 1. You finally have to (get to?) use the new diagnosis coding system (but remember that CPT and all the associated location [RT, LT, E1-E4] and payment [25, 58, 79, etc.] modifiers do not change). You can’t avoid ICD-10 now, except with the very few payers…

Read More