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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Medical Record Signature Options – Retinal Physician

Medicare offers multiple ways to meet the requirement. Everyone knows that medical records must be signed to be valid. Let’s review Medicare’s specific requirements. Does Medicare look at provider signatures during an audit? What are Medicare’s signature requirements? What does Medicare consider an acceptable signature? What is a signature log? What is an attestation statement?…

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The Lowdown on Compounded Medications – Retinal Physician

Customization and lower costs help give these medications an essential role in patient care. Medications compounded for individual patients are an important part of health care. This article discusses what they are and their importance in a retina practice. This article addresses the following questions: What is a compounded medication? Why are compounded medications prescribed?…

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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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Intravitreal Medications for Geographic Atrophy – Retinal Physician

Billing questions will arise with new drug treatment. According to the American Academy of Ophthalmology EyeWiki, “Geographic atrophy is a chronic progressive degeneration of the macula, as part of late-stage age-related macular degeneration (AMD). The disease is characterized by localized sharply demarcated atrophy of outer retinal tissue, retinal pigment epithelium and choriocapillaris. It starts typically…

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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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Coding Guidelines for Principal Care Management – Retinal Physician

Unlike some other “care management” codes that require the physician manage a patient from head to toe, principal care management (PCM) is applicable to a specialty practice such as ophthalmology. This may be a useful addition to your retinal practice. This article addresses the following questions: What is principal care management? What is “high risk”…

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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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