Reimbursement Rules for Intravitreal Injections – Retinal Physician

With audits likely on the way, it’s worthwhile to brush up. Intravitreal injections (IVIs) are a mainstay of retina practice. Still, it is worthwhile reviewing the reimbursement issues of this common procedure. This is especially true now, with Medicare and other payers focusing audits on the procedure. This article addresses the following questions: What conditions…

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The Decision to Dilate – Retinal Physician

Some patients come to your office for an eye exam and refuse to be dilated. Dilation is almost always harmless in the long term, but it does come with short-term side effects, including light sensitivity, blurry vision, difficulty driving immediately after dilation, trouble focusing on close objects, and stinging when the drops are instilled. So,…

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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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Your EO Coding Needs Work – Retinal Physician

Coding and documentation requirements for extended ophthalmoscopy (EO) changed in 2020. We continue to receive questions about proper use of these tests, and we see increasing issues in payer audits of retinal specialists. This article addresses the following questions: What is extended ophthalmoscopy? What is the difference between codes 92201 and 92202? What diagnoses support…

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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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Auditing Medical Records – Retinal Physician

With federal agencies stepping up investigations, it’s imperative that you establish a first line of defense. Every practice should have a self-auditing program. Here’s what you need to know to create an effective one. This article addresses the following questions: Why should we consider auditing our medical records? What is the objective of a chart…

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Avoiding Audit Traps for Intravitreal Injections – Retinal Physician

Medicare pays out a lot of money for these treatments, so expect close scrutiny. Retina specialists perform many intravitreal injections. Their frequent use means they can garner extra attention from the Centers for Medicare and Medicaid Services (CMS). This article addresses the following questions: Why is Medicare focusing on these claims? What can we do…

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Coding Changes in 2022 – Retinal Physician

Two codes see changes to their global periods, plus physician reimbursement. The year 2022 has brought many significant changes in the Medicare program, including another last-minute cliffhanger for physician reimbursement. This article addresses the following questions: What 2022 coding changes affect retina? What else is happening with physician reimbursement?

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The Ins and Outs of Medicare’s Global Surgery Rules – Retinal Physician

The rules have been with us for decades, but questions remain. Current global surgery rules for Medicare have been in place since 1992, and most other payers follow Medicare guidelines. Sometimes, however, we still get questions. Here’s our guidance. This article addresses the following questions: What is Medicare’s global surgery policy? What services are excluded?…

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