Coding the Aborted MIGS – Ophthalmology Management

With the increased utilization of minimally invasive glaucoma surgery (MIGS) surgery in combination with cataract procedures, we find more instances where part of the planned procedure cannot be completed. Correct billing depends on why the procedure was stopped. This article addresses the following questions: Can you give an example? How should we bill the incomplete…

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Dry Eye Disease and DEWS II – Ophthalmology Management

Dry eye disease (DED) affects millions of patients worldwide and is a common reason to seek eye care. A variety of DED therapies are available, but because DED varies in severity between patients no single therapy works for everyone. Evaluation and management of DED relying on evidence-based medicine is the best approach. This article addresses…

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At Last: 2023 CMS Updates – Ophthalmology Management

There are some important changes in the Medicare program for 2023, and yet another last-minute cliff-hanger for physician reimbursement. This article addresses the following questions: What are the 2023 changes? Are there any new codes for ophthalmology? What’s happening with physician reimbursement?

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Not Coded vs Not Covered – Ophthalmology Management

Many practices assume that services without regular CPT codes are automatically non-covered and payable by the patient. That isn’t necessarily the case. What can you do about it? This article addresses the following questions: Aren’t Category III codes and miscellaneous codes non-covered? How are we supposed to know if a service is covered or not?…

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2023 To Bring More Changes To E/M Codes – Ophthalmology Management

Remember the overwhelming changes to evaluation and management (E/M) coding for exams and most outpatient services that happened in 2021? The same types of changes are being applied in 2023 for other E/M codes. While most ophthalmology practices mainly focus on office-based E/M services, other services are also provided. This article addresses the following questions:…

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Modifier 25 Review – Ophthalmology Management

Using modifier 25 will often get your exam claim paid — but know when to use it correctly. Are you allowed to bill for an eye exam on the day of a minor surgical procedure? If you haven’t looked at this question lately, you may be surprised. Using modifier 25 will often get your exam…

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Cataract Surgery and Glaucoma Stents – Ophthalmology Management

Cataract surgery is frequently performed in conjunction with glaucoma stent procedures. In 2022, we have new CPT codes to describe these combination procedures. This article addresses the following questions: What glaucoma stent procedures are performed with cataract surgery? What are the new CPT codes? Is there reimbursement for the stent procedures without cataract surgery? What…

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When The Irrigating Solution is a Drug – Ophthalmology Management

Since Omidria’s FDA approval in 2014, ophthalmic surgeons have been using the drug intraoperatively to reduce the need for pupil-expanding devices in femtosecond laser-assisted cataract surgery and standard phacoemulsification, as well as reduce surgical complications and postoperative pain. Here are the ins and outs of reimbursement. This article addresses the following questions: What is Omidria?…

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Beware The EO/Imaging Overlap – Ophthalmology Management

Extended ophthalmoscopy (EO; CPT 92201, 92202) and imaging of the retina (CPT 92250, 92134, 92235, 92240, 92242) are overlapping services. This overlap often leads to confusion as to whether both may be reimbursed when performed the same day. When EO and imaging are performed concurrently, reimbursement depends on these tests finding different information. This article…

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A Different Look at Bundled Services – Ophthalmology Management

At this time, we are all fairly well acquainted with the National Correct Coding Initiative (NCCI) edits published by CMS. The “bundles” mean that you bill for the primary procedure but not for incidental services. Additionally, those codes identified as “mutually exclusive” cannot be reimbursed together in the same session. CMS developed NCCI to prevent…

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