Optometry Coding & Billing Alert

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Optometry Coding & Billing Guidance: From Regulatory Updates to Code Set Changes!

As an optometry service provider, you should now be ready to use the 2016 CPT® changes. You’re also dealing with the challenges, issues and difficulties of the new ICD-10 system, which went into effect Oct. 1. Are you sure you know everything you need to know to file clean and compliant claims and get the reimbursement your optometry practice deserves?

ICD-10 Expands to Over 100 Pages of Eye Care Codes

The ICD-10-CM system consists of more than 69,000 codes, compared to approximately 14,000 ICD-9-CM codes. Optometry practices will have to deal with increased specificity such as bilateral eye diagnosis codes (right, left, bilateral, and unspecified). Parasitic endophthalmitis codes go a step further and specify which part of the eye (for instance iris or retina) is affected!

Your practice will need all the help it can get!

2016 CPT®, HCPCS Updates, CCI/NCCI Edits and OIG Guidelines

Plus: Although gonioscopy — CPT® code 92020 — is one of the top 25 procedures billed by optometrists, there are a lot of myths and misconceptions attached to it. Other eye care procedures have their challenges, as well. For instance you may be wondering:

  • How you can get paid for refraction even when the patient doesn’t have vision insurance?
  • E/M codes vs. general ophthalmological services codes: Which should you report for an office visit?
  • What are the bilateral vs. unilateral rules for various diagnostic procedures?


Also, don’t forget about CCI edits, HCPCS updates, and OIG guidelines among other general reimbursement and compliance changes!

Why put your coding and deserved pay at risk? Turn to a trusted resource that hundreds of optometry practices rely on: The Coding Institute’s Optometry Coding and Billing Alert.

Here’s a sample of what we’ve covered in recent issues of Optometry Coding and Billing Alert.

  • ICD-10: Focus on H44 codes for endophthalmitis, other disorders of globe.
  • ICD-10: How to report congenital eyelid malformations.
  • E/M Coding: 3 ways comparative billing reports can rescue your coding.
  • How to report patients’ vague, generalized complaints — blurry vision, dry eyes, or foreign-body sensation.
  • Get plugged in to punctal plug reimbursement.
  • Pre-cataract surgery tests: 76519, 92136: Understand bilateral rules for accurate reimbursement.
  • 373.0, 375.15, or 372? Get the eye irritation details to find best Dx code.
  • E/M codes: How eye code requirements are completely different.
  • Eye exams: 92004 and 92014: Can you code comprehensive exams without dilation?
  • How to report multiple foreign bodies in the eye — Can you code each one separately?
  • Visual fields: Clarify your VF coding for glaucoma suspects.
  • Common IOL power calculation myths — is one of them tripping up your practice?

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