OPTOMETRY MEDICAL BILLING-Less than 80 days to ICD-10 - CMS and AMA Announce Efforts to Help Providers

Many offices have contacted us regarding ICD-10 over the last few years. Lately these requests for help have become more ernest. While I have traditionally told people that I didn't believe it was the year for ICD-10 to FINALLY become mandatory, all signs are currently pointing to "yes" for this year. I will still hold out till Oct 1 to be certain BUT it is still good to be prepared.

In July Medicare announced that It will not deny claims coded with ICD-10 that don't use high specificity...at least not at first. That means that if you have the ability to translate an icd-9 code to an icd-10 code directly, not highly specific in terms of ICD-10, you will likely not receive a denial for that. However, this is a temporary solution so you shouldn't rest on your laurels.

Here is an excerpt of the original announcement put out by Office Ally:

"According to the CMS, for one year after Oct. 1, 2015, Medicare will not deny physicians or other practitioners Part B claims based solely on the specificity of the ICD-10 diagnosis code as long as the provider used a valid ICD-10 code from the right family. In addition, quality reporting will also receive a grace period, as long as a valid ICD-10 code from the correct family of codes is used. Moreover, if a Part B MAC is unable to process claims within established time limits because of administrative problems, an advance payment may be available. CMS will also have an ICD-10 Ombudsman to help receive and triage provider issues. "

I still do not believe that it is in our best interest to implement ICD-10 while the rest of the world is already moving to ICD-11 but that is a different argument for a different day.

Click here to learn more about the CMS/AMA announcement.
Click here for the guidance/FAQ from CMS.

Contact opticXpress today for more info about OUR medical billing services!

Optometric Billing-Medicare Id Number Suffixes

Ever Wonder what the letters at the end of a patient's Medicare ID# mean? I always did too at one time so I decided to share it with all of you.

As originally published by the Council of Nephrology Social Workers:

*A = retired worker
  B = wife of retired worker
  B1 = husband of retired worker
  B6 = divorced wife
  B9 = divorced second wife
  C = child of retired or deceased worker; numbers after C denote order of children claiming benefit
  D = widow
  D1 = widower
  D6 = surviving divorced wife
  E = mother of a child of a deceased worker
  E1 = divorced mother of a child of a deceased worker
  F1 = aged dependent father
  F2 = aged dependent mother
*HA = disabled worker HB = wife of disabled worker
  HC = child of disabled worker
*J1 = special “over 72” benefit, has A and B
  K1 = wife of “over 72” benefit, has A and B
*M = has Part B Medicare only, no SSA benefit
 *T = has A and B Medicare, no SSA benefit
  W = disabled widow
  WA = railroad retirement

*denotes the recipient’s own social security number.

If you ever have any questions about Optometric Medical Billing (also known as Optometry Billing), click here to contact us today or call 866-688-3335.

OPTOMETRY BILLING-BCBS OF VT-TIMELY FILING

Just as an FYI to all Vermont BCBS providers:

After a brief phone consultation with Provider Services at BCBS of VT, it is confirmed that ALL CONTRACTED providers with BCBS VT have a timely filing limit of 6 months. There is one known exception: patients who went under VT Healthconnect to purchase insurance that became active Jan 1 of 2014 and DID NOT update their insurance info with their provider could have their claim re-opened in the event of a timely filing incident.

For help with optometric billing contact opticXpress today by CLICKING HERE or calling (866)688-3335.

OPTOMETRY BILLING-SPECTERA ELECTRONIC CLAIMS SUBMISSIONS

opticXpress is pleased to announce that we are now online with Spectera as an approved clearinghouse to submit claims to them electronically. Providers will still have to sign up with optum-payments to receive Electronic Remittance Advices and request EFT however, which is a let down, but this is a step in the right direction for an insurance company that is arguably one of the most archaic and backwards thinking insurance companies in the market (most vision plans are similar, as well all know!).

Contact opticXpress today by CLICKING HERE or calling (866)688-3335 and let us be your go-to optometry billing service!

Optometry Billing-Medicare, VSP and Others Increase Audits

* "Medicare, Blue Cross, VSP and ALL  other payers have increased their audits. They know that most practice's documentation is NOT COMPLIANT! Typical Penalties are between $100,000 and $200,000 ! Most practices fail these audits. "





*This came from our friends at Eyecor. opticXpress is a re-seller of Eyecor coding software you can contact us by clicking here to get more info about this ground breaking software. For help with a pending insurance Audit, a Past Insurance Audit or to protect yourself from a possible future audit please contact Eyecor's Nteon Practice consultants by clicking here. 

Nteon Practice Consultants are experienced in what auditors are looking for. They have conducted many audits throughout the country and these audits include a review of compliant documentation, reports, HIPPA and lost reimbursements just to name a few.

Optometric Billing-The Best in The World!

CALL OPTICXPRESS TODAY!

Optometric Billing-Patient Payment Expectations...UPFRONT!

For years I have been yelling at the top of my lungs about the need for optometrists to tell patients UPFRONT, THAT YOU EXPECT TO GET PAID IF THE INSURANCE COMPANY DOESN'T and to collect a payment method AT THE TIME OF SERVICE!

But no one listens. You are all to scared to piss off your patients because you are worried you will lose them if you do. None of you stop to think that if you let a patient get away with not paying you, you are not keeping the patient anyway because if they know they owe you money THEY STILL WILL NEVER COME BACK! It all boils down to the same thing...you always think you are right, and you think no one else knows your business. Well guess what, those of us that are actually in charge of your money actually know a great deal about your business and in most cases (except providing actual healthcare) we know MORE THAN YOU DO ABOUT YOUR BUSINESS!  That is because we are trained business men, at least I am, and you are a TRAINED DOCTOR. It is my job to count dollars and cents and it is your job to provide healthcare. Stop trying to be superman (or woman). Stop trying to wear so many hats (or capes) in your practice. Entrust those you hire to care for the health of your practice...TO CARE FOR THE HEALTH OF YOUR PRACTICE, while you worry about the health of your patients!

That being said, Instamed has posted on their blog an article outlining this exact problem in health care practices. Unfortunately for optometry, the numbers are even worse than what this article details because of the reason I expressed above. Here it is below:

"When you stay at a hotel, are you able to check in without giving your payment card?  Of course not. However, patients receive access to healthcare services with no assurance that they will pay their portion of the bill on time, or at all. As a result, you may spend up to 90 days, send multiple paper statements and even make phone calls to collect payments.  And frequently, the payment is written off as bad debt.  This is costing your business a lot of money.
Providers have opportunities to use Smart Big Data and technology to accurately estimate patient responsibility and automatically collect payments, which creates a level of payment assurance already happening in consumer-focused industries.
Transforming the Collection Process with Smart Big Data
Here’s how Smart Big Data transforms the collection process:

1. Before the patient visit, verify patient eligibility information and generate an estimate of the patient’s payment responsibility, using data stored from payer remittance information.
2. Automatically send a communication to the patient to set clear payment expectations upfront.
3. Securely save the patient’s payment card on file.
4. When the claim is adjudicated, automatically collect the exact amount due, or set up an automated payment plan.  As a best practice, send another communication to the patient to remind them of their payment.
5. Automatically post the payment to your accounting system.

When providers can leverage Smart Big Data to accurately estimate patient responsibility in real-time, it becomes functional on a day-to-day basis, enabling you to efficiently collect payments and thrive in the evolving healthcare industry."
(https://www.instamed.com/blog/finding-payment-assurance-in-the-healthcare-industry-with-smart-big-data/)

Click here and contact opticXpress today. Let us worry about your business while you worry about your patients.

Optometric Billing-Billing for Contact Lens Training

When doing my usual look up of site stats for The Optometric Billing spot today, I noticed that someone Googled us using the following key word: "can you bill for contact lense training" . 

I was a bit baffled by this considering that this is historically considered part of the contact lens fitting but I figured I would look 
it up for you cause it piqued my interest. So, here is what I came up with. NO, YOU CAN NOT SPECIFICALLY BILL SEPARATELY FOR 
THE TRAINING. The one area where you might be able to get away with it is insurance companies that take "S" codes
as there is an "s" code for Comprehensive Contact Lens Evaluation. However, I doubt the reimbursement is even worth your time.
I also doubt that insurance company would let you bill for both a Contact lens fitting (92310) and the Comprehensive Evaluation
(S0592) for the same patient, but maybe someone better than I can figure that out for you. 

Bottom line, as always in the Medical Vs. Insurance world....Play it safe and don't get greedy!

Need help with insurance billing? Want as close to a guarantee as possible that you will get paid for EVERY insurance claim yousubmit to insurance? 

Click Here to contact opticXpress today. If you send us your claims, chances are, they will get paid the first time,

WE GUARANTEE IT!*

Optometric Billing-By opticXpress

Call opticXpress or CLICK HERE to visit our website, today.

(866)688-3335

Optometric Billing-Affordable Care Act (Obama Care), Letter From President Obama

I got this letter from the President of The United States earlier today, I just wanted to share it with everyone.

"Hello everyone,

Last night, the first open enrollment period under the Affordable Care Act came to an end.

And this afternoon, we announced that 7.1 million Americans have now signed up for private insurance plans through the new Health Insurance Marketplaces.

7.1 million.

That doesn't count the more than 3 million young adults who have gained insurance under this law by staying on their families' plans. It doesn't count the millions more who have gotten covered through the expansion of Medicaid and the Children's Health Insurance Program. It doesn't include the more than 100 million folks who now have better care -- who are receiving additional benefits, like mammograms and contraceptive care, at no extra cost.

Now, millions of our fellow Americans have the comfort and peace of mind that comes with knowing they're no longer leaving their health and well-being to chance. For many of them, quality health insurance wasn't an option until this year -- maybe because they couldn't afford it, or because a pre-existing condition kept them locked out of a discriminatory system.

Today, that's changed. And while our long-broken health care system may not be completely fixed, it's without question a lot better. That's something to be proud of -- and there's no good reason to go back.

Regardless of your politics, or your feelings about the Affordable Care Act, millions more Americans with health coverage is something that's good for our economy and our country.

At the end of the day, that is what this law -- and the other reforms we're fighting for, from a 21st-century immigration system to a fairer wage for every American who's willing to work for it -- are all about:

Making sure our country lives up to our highest ideals.

I am thankful to be your President today, and every day. And I am proud that this law will continue to make life better for millions of Americans in the years to come.

Thank you.

President Barack Obama"

Somewhere in there he forgot to mention that now, millions of more people will be insured to walk through your optometry practice doors and create an optometric billing nightmare for your billing staff because many, many, many of these newly insured patients, as well as the patient's that have been with you for years, are going to get hit with sky-high deductibles that average anywhere from $3k-$10k per year. 

Patients barely want to pay their co-pays now as it is,do you really think it is gonna be any easier to get them to pay for their entire exam out of pocket due to ridiculously high deductibles and co-insurances? Somewhere, I bet the board members of Care Credit are cracking open bottles of Dom Perignon and cases of Cuban Cigars while they laugh...all the way to the bank.

Avoid hastles. Click here to let opticXpress become your biling department today.

Optometric Billing-Claims to Be Held by Medicare per Congressional Request

Information Regarding the Holding of April 2014 Claims for Services Paid Under the 2014 Medicare Physician Fee Schedule
The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1, 2014. That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013, which provided for a 0.5 percent update for services paid under the MPFS through March 31, 2014.

CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1, 2014. CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (i.e., through April 14, 2014). This hold would only affect MPFS claims with dates of service of April 1, 2014, and later. The hold should have minimal impact on provider cash flow, because under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt. All claims for services delivered on or before March 31, 2014, will be processed and paid under normal procedures, regardless of any Congressional actions.

You can always contact opticXpress for help with your optometric medical billing and avoid having to worry about these things yourself. Please click here for more info.

Optometric Billing-Why I HATE Office Mate-Part 1

I have been meaning to write this for a long time but for some reason, all I have done is just collect evidence on the subject without actually pulling the trigger on the situation. Hell, I even sent the software designers some of the screen shots that I am going to share with you in an effort to get them to fix these important mistakes BEFORE releasing a new version of the software....it didn't work. So, I am here today to begin my attack on Office Mate.

Office Mate is by far, the worst piece of crap that has ever been sold to the optometric community. I can go into a million reasons as to why but for the purpose of these posts, I am only going to highlight the issues that I can explain to you visually. That is, I have photo documented proof of why you shouldn't spend your money on this piece of Sh88, and if you did these photos prove that you should not only stop using office mate, you should fight tooth and nail to get your money back.

Lastly, before I begin, I want to point out that after speaking to various high level technicians and programmers at office mate ( or eyefinity or who ever the hell owns these people), every single one of the issues that I am going to share with you has been acknowledged by office mate as "known of for quite sometime, program works as designed. No Immediate plans to fix." Did you hear that in your mind as you read that last sentence? OFFICE MATE DESIGNED THIS TO WORK WRONG AND HAS NO PLANS TO FIX IT!

Now, without further adue:

PROBLEM #1: FEE SLIPS DON'T CORRECTLY CARRY OVER TO CLAIMS

In the above image, this patient's exam was coded using  Exam Writer and each diagnosis code was correctly pointed to the respective procedure codes as the Dr. here wanted them submitted to the insurance company. However, when the exam was carried over to the fee slip by our secretary, only #2 diagnosis code appeared on the fee slip for her to choose from. When I received the claim in "3rd party processing" at the end of the day, the above is what I got. The Dr. had actually pointed 1,2,3,4 to proc code 1 when she charted that day and used #2 for the PQRS codes, yet how is it that the claim in the picture above was generated? 

WHAT DOES THIS PROBLEM MEAN TO THE AVERAGE OFFICE MATE USER?

The average optometry practice does not have a billing department and may not have an actual biller. The job of batching claims and submitting to the insurance company is usually left to a secretary, office manager, another un-qualified individual in the office or the doctor. None of these named individuals have the time, desire and in many cases, knowledge to properly research and correct the error above on a daily basis. In fact, most offices don't even batch and submit on a daily basis, many do it weekly. What if you had to fix EVERY CLAIM for 10,20,30 or even 50 patients at the end of a long week? The issue above is a primary reason why claims generated by office mate can't be trusted. 

CRAP CLAIMS LIKE THE ONE ABOVE LEAD TO A LOSS OF PRECIOUS REVENUE IN MANY PRACTICES IN THE UNITED STATES.

Optometric Billing at Saratoga Springs!

This weekend, March 22-24, opticXpress will be hosting an exhibit at the Saratoga Springs Coding Conference in Saratoga Springs, NY. We encourage you to come visit us and see what we have to offer and what we are all about.

We will also be joined at our table by the president of Liquid EHR which is our choice for clients that need high quality EHR software. Also, we will be highlighting our free billing software and EyeCor, coding software for OD's.

We hope to see you there!

For more info, please call us at 866-688-3335 x1.

Click Here to Let opticXpress Become Your Optometric Billing Service Today.

Optometric Billing-opticXpress Updates Web Page

opticXpress has updated their webpage. It now includes easier access to information about services, the ability for patients to logon and pay invoices they have revamped it throughout with cleaner, more concise text.

Click Here to Have a Look Today.

Optometric Billing-New 1500 Claim Form

In case you are not aware, though I am sure you are, there is a new 1500 claim format going into effect April 1. After looking over the attached manual there are many changes going into effect that you as a billing person or doctor's office should be aware of. Below you will find a copy of the most recent new 1500 claim form and a link to the intsruction manual for filling this out. It would be in your best interest to print out the form and fill it in with "dummy" information according to the attached instructions as many times as needed in order to familiarize yourself with the information and new form.

Instruction Manual Contained Here

As always, opticXpress can handle all your billing needs and help you ease the transition to this new format. 

Click Here and Call Us Today!

Optometric Billing-Vermont Medicaid Timely Filing Limits

As Per Section 8.1 of the Vermont Medicaid Timely Filing Manual:

1) When Vermont Medicaid is Primary the timely filing limit is 6 months (one of the shortest in the nation):

When the system indicates that Vermont Medicaid is the primary payer, the timely filing

limit for such claims is six months from

the date of service.  In no case will a claim be

considered if the date of service is greater than two years prior to the DVHA’s receipt of

the claim. If a claim has a date or dates of service past the timely filing limit, it may be

submitted for payment directly to HPES if one or more of the following conditions are

met:

•HPES denied the claim within the timely filing limit for a reason other than

exceeding the

time limit. A copy of the remittance advice showing the denial must be

attached to each

claim.

•Abeneficiary’s eligibility was made retroactive and the date of service is within the

retroactive period. The claim must be submitted within the first twelve months of

thedate on the Notice of Decision. Include a note with the claim stating the

retroactivedate

of eligibility.

•Inpatient claim, the timely filing limit is 180 days from the date of

discharge. 

2) Crossover Claims-you have 2 years (weird but true):

When a claim is billed to Medicare with Vermont Medicaid noted as the secondary payer

(using the crossover function), the crossover claim will be

considered timely if it is

received within two years of the date of service.

opticXpress specializes in Medicare and Medicaid billing for optometrists. We also handle the billing of ALL other insurance companies as well, espescially our home state of Vermont. 

Click Here now to let opticXpress be your optometric billing company or clearinghouse today!

Optometric Billing-Submitting Refractions to Medicare-92015

For those of you who are not sure, you can not bill Medicare for a refraction...it is considered to be part of an eye exam by default and is therefore "statutorily excluded" from being billed (ref: EyeCor, 2014). However, you do have options.

1) You can bill your patients at the time of service for this service, ALWAYS MAKE SURE TO GIVE YOUR PATIENTS AN ABN (CALL opticXpress at 866-688-3335 x1 if you need a copy of one) informing them in advance of your intention to do this.
2) Don't bill Medicare for the refraction at all
3) Include the refraction on your claim but use a "GY" modifier. This will signify to Medicare that you know this service is not covered and you have informed of this via an "ABN". (Hint; if you chose option 1, you will need to perform option 3 as well).

 As always, opticXpress is here to help! Click here to contact us today and let us handle your optometric billing for you!

Optometric Billing-VSP to Begin Covering Google Glass

The following text was copied from a January 28 article in "Optometry Times". This will most likely affect optometric billing personnel over the coming months and it would be a good time to start aquainting yourself with these developments. I am sure that many other insurance companies will begin following suit, espescially if it proves to be popular. It will also be a good way for an optometric practice to provide cutting edge technology to its patients and customers and one more reason to get people through your doors.

Begin Article:
San Francisco, CA*VSP and Google have reached a deal to offer subsidized frames anq
prescriptlon lenscs for Google Glass.
"We know our 64 million members are seeing and hearing about Google Glass and how itwill affect
their lives and vision, so we are really focusihg on the eye health management perspective," says
Jim lvlcGrann, president of vsP vision caro, vsp's insurance division, which insures one-fifth of
Americans.
Google plans to sell Glass to the public lator this year, While it did not originally offer traditional
framos or prescription lenses, early Glass owners "hacked" the device to add prescription lenses
an0 sungtasses.

Now, Google has designed 4 styles-curvy, thin, split, and bold, all shown above*made of
lightweight titanium, and plans to offer 2 new styles of sunglasses. The color, frame, and shade
choices will offer 40 style variations for Glass.

Justin lJazan, OD, Optometry flmes Editorial Advisory Board member, speaking exclusively, says
ho hopes VSP's decision to cover Google Glass will bring in new customers looking for prescription
versions of the much-hyped new device.

"Being able to provide €yewear that incorporates revolutjonary technology will make us more
valuable to our patients," says Dr. Bazan.

VSP and Google croated a training program foroptometrists to learn howto mount Glass on frames
and fit thc device on patients. '[he companies have alroady begun training ODs in New york City,
San Francisco, and Los Angeles, although they have not said how many ODs have been tralned.
"VSP providers can prepare online. I got an e-mail directing to me a specifically designed Web site.
I watched a video, took a quiz, signed a non-disclosure document and then was told something like
'Congratulations. Your VSP Glass welcome package will be mailed to you. Expect it in a week or
so,"'says Dr, Bazan.

VSP's lab rn Sacramento, Cn, will cut lenses for Glass frames. Google Glass costs g1,SOO for thosc
invited to buy the current version, but it will retail for several hundred dollars less when it is
introducod to the public later this year. The titanium frames will retail for $225. VSP will reimburse
members based on their plan, with an average reimbursoment of $120, plus the costs of buying
prescription iensos. lt will not subsidize the computer portion of Glass.

"Smart glasses may or may not find their way into our practices. -fhere
are companies out thero that
aro likely to do everything online and skip using an eyecare provider. In fact, I would say it's only a
matter of time before we see smart glasses available direct from the manufacturer
or reseller online," says Dr. Bazan.ODT

CLICK HERE TO CONTACT OPTICXPRESS FOR HELP WITH YOUR OPTOMETRY BILLING TODAY!

Optometric Billing-92225-Ophthalmoscopy Extended w retinal drawing - Initial-Acceptable DX Codes

We have done numerous posts on the 92225 proc code. My main reason for this is because it is highly abused among optometrists and optometric billers and billing staff alike. Therefore, in an effort to continue to provide more clarity on this subject I am publishing a list of acceptable Diagnosis Codes that can be reported to Medicare (and most other insurances) when billing for this procedure. I would like to point out that this list is based on Texas medicare Local Coverage Determinations (LCD's) but it is a good reference point for any state as variations in the rule are minute. If you have any questions about your state, feel free to contact Andrew Roy at 802-253-7201 and we will help you find the EXACT DX codes for your state.

Allowed Reimbursamble Diagnoses Pertaining to 92225

115.02                 Retinitis - Infection by Histoplasma Capsulatum [American histoplasmosis - Darling`s disease]

130.2                   Chorioretinitis Due To Toxoplasmosis

190.5                   Malignant Neoplasm - Retina

190.6                   Malignant Neoplasm - Choroid

224.5                   Benign Neoplasm - Retina  [Retinal Nevus]

224.6                   Benign Neoplasm - Choroid [Choroidal Nevus]

228.03                 Hemangioma of Retina

228.09                 Hemangioma - Other Sites

282.60                 Sickle-cell Disease, Unspecified

282.64                 Sickle-cell/Hb-C Disease With Crisis

282.68                 Other Sickle-cell Disease Without Crisis

360.01                 Endophthalmitis - Acute

360.21                 Progressive High (degenerative) Myopia - Malignant myopia

361.00                 Retinal Detachment - Defect - Unspecified

361.01                 Retinal Detachment - Recent - Partial - One Defect

361.02                 Retinal Detachment - Recent - Partial - Multiple Defect

361.03                 Retinal Detachment - Recent - Partial - Giant Tear

361.04                 Retinal Detachment - Recent - Partial - Dialysis

361.05                 Retinal Detachment - Recent - Total or Sub-total

361.06                 Retinal Detachment - Old - Partial

361.07                 Retinal Detachment - Old - Total or Sub-total

361.10                 Retinoschisis - Unspecified

361.11                 Retinoschisis - Flat

361.12                 Retinoschisis - Bullous

361.13                 Retinal Cysts - Primary

361.14                 Retinal Cysts - Secondary

361.19                 Other Retinoschisis And Retinal Cysts

361.2                   Retinal Detachment Serous - without retinal defect

361.30                 Retinal Defect - Unspecified w/o Detachment

361.31                 Retinal Hole w/o Detachment

361.32                 Retinal Tear w/o Detachment

361.33                 Retina - Multiple Defects w/o Detachment

361.81                 Retinal Detachment - Tractional

362.01                 Background Diabetic Retinopathy

362.02                 Proliferative Diabetic Retinopathy

362.03                 Nonproliferative Diabetic Retinopathy

362.04                 Mild Nonproliferative Diabetic Retinopathy

362.05                 Moderate Nonproliferative Diabetic Retinopathy

362.06                 Severe Nonproliferative Diabetic Retinopathy

362.07                 Diabetic Macular Edema

362.10                 Background Retinopathy - Unspecified

362.12                 Retinopathy - Exudative - Coats` syndrome

362.13                 Changes In Vascular Appearance of Retina - Vascular sheathing of retina

362.14                 Retinal Microaneurysms - NOS

362.15                 Retinal Telangiectasia

362.16                 Retinal Neovascularization - NOS

362.21                 Retrolental Fibroplasia [Cicatricial retinopathy of prematurity]

362.31                 Central Retinal Artery Occlusion

362.32                 Arterial Branch Occlusion

362.35                 Central Retinal Vein Occlusion

362.36                 Venous Tributary (Branch) Occlusion of Retina - BVRO

362.41                 Retinopathy - Central Serous

362.42                 Serous Detachment of Retinal Pigment Epithelium [Exudative detachment]

362.43                 Hemorrhage Detachment of Retinal Pigment Epithelium

362.52                 Macular Degeneration - Exudative Senile (WET) [Kuhnt-Junius degeneration]

362.53                 Macular Degeneration - Cystoid

362.54                 Macular Cyst or Hole or Pseudo-hole of Retina

362.56                 Macular Puckering [Preretinal Fibrosis, Epiretinal membrane]

362.63                 Lattice Degeneration of Retina [Palisade degeneration of retina]

362.74                 Pigmentary Retinal Dystrophy [Retinitis Pigmentosa, Albipunctate]

362.81                 Retinal Hemorrhage

362.83                 Retinal Edema [Cotton Wool Spots, Macular, Peripheral, Localized]

362.84                 Retinal Ischemia

363.00                 Focal Chorioretinitis - Unspecified

363.01                 Focal Choroiditis and Chorioretinitis - Juxtapapillary

363.03                 Focal Choroiditis and Chorioretinitis of Other Posterior Pole

363.04                 Focal Choroiditis and Chorioretinitis - Peripheral

363.05                 Focal Retinitis and Retinochoroiditis - Juxtapapillary [Neuroretinitis]

363.06                 Focal Retinitis and Retinochoroiditis - Macular or Paramacular

363.07                 Focal Retinitis And Retinochoroiditis of other Posterior Pole

363.08                 Focal Retinitis And Retinochoroiditis - Peripheral

363.10                 Disseminated Chorioretinitis - Posterior

363.11                 Disseminated Chorioretinitis - Unspecified

363.12                 Disseminated Chorioretinitis - Peripheral

363.13                 Disseminated Chorioretinitis - Generalized

363.14                 Disseminated Retinitis and Retinochoroiditis - Metastatic

363.15                 Disseminated Retinitis and Retinochoroiditis - Pigment Epitheliopathy [Acute posterior multifocal placoid]

363.20                 Chorioretinitis - Unspecified [Choroiditis NOS, Retinitis NOS, Uveitis posterior NOS]

363.21                 Pars Planitis [Posterior cyclitis]

363.22                 Harada`s Disease

363.30                 Chorioretinal Scar - Unspecified

363.70                 Choroidal Detachment [Commotio Retinae, Choroidal Hemorrhage]

363.71                 Choroidal Detachment - Serous [Commotio Retinae, Choroidal Hemorrhage]

363.72                 Choroidal Detachment - Hemorrhagic [Commotio Retinae, Choroidal Hemorrhage]

365.10                 Open-angle Glaucoma Unspecified [Wide-angle Glaucoma NOS]

365.11                 Primary Open Angle Glaucoma [Chronic, Simple, Noncongestive, Nonobstructive]

365.12                 Low Tension Open-angle Glaucoma

365.13                 Pigmentary Open-angle Glaucoma

365.14                 Glaucoma of Childhood [Infantile, Juvenile Glaucoma]

365.20                 Primary Angle-closure Glaucoma Unspecified

365.21                 Intermittent Angle-closure Glaucoma [Interval, Sub-acute]

365.22                 Acute Angle-closure Glaucoma [Attack, Crisis]

365.23                 Chronic Angle-closure Glaucoma

365.24                 Residual Stage of Angle-closure Glaucoma

365.31                 Corticosteroid-induced Glaucoma Glaucomatous Stage

365.32                 Corticosteroid-induced Glaucoma Residual Stage

365.42                 Glaucoma Associated With Anomalies of Iris [Anomalies NEC, Atrophy, Essential]

365.44                 Glaucoma Associated With Systemic Syndromes

365.62                 Glaucoma Associated With Ocular Inflammations

365.63                 Glaucoma With Vascular Disorders of Eye

365.65                 Glaucoma Associated With Ocular Trauma

368.15                 Other Visual Distortions and Entoptic Phenomena [Refractive: diplopia; polyopia; Photopsia; Visual halos]

379.21                 Vitreous Degeneration [Vitreous cavitation, detachment, liquefaction]

379.23                 Vitreous Hemorrhage

379.24                 Other Vitreous Opacities [Vitreous Floaters, Vitreous Syneresis]

379.26                 Vitreous Prolapse

379.29                 Other Disorders of Vitreous

379.34                 Dislocation - Posterior Lens

871.5                   Penetration of Eyeball with Magnetic Foreign Body

871.6                   Penetration of Eyeball with Nonmagnetic Foreign Body

996.53                 Mechanical Complication Due To Ocular Lens Prosthesis

E931.4                Antimalarials/Drugs Acting On Other Blood Protozoa Causing Adverse Effects In Theraputic Use

V58.69                Long-Term (current) Use of Other Medications Need Help With other Codes or Just want a full time billing department to handle your optometric billing? Click here to contact opticXpress now!

Optometric Billing-92132-Scanning Computerized Ophthalmic Diagnostic Imaging ANTERIOR Segment

Billing for 92132 is rather straightforward.
1) The procedure is considered Unilateral or Bilateral-This means you can either bill for it once, if it is both eyes or ammend it with an RT or LT modifier
     EX: 92132 (for both eyes) 92132-RT( for right eye only) or 92132-LT (for left eye only)
2) The procedure is considered to mutually exclusive of 92285 (External Ocular Photography For Documentation of Medical Progress ) which means you can bill the 92132 with the 92285 but you must have a separate diagnosis code for the 92285 and MAY have to use a 59 modifier.
3)Never bill 92132,92133 or 92134 on the same day, bring your patients back on separate days to do these procedure as they are generally done with the same machine and therefore will be considered to be one procedure. If you were to bill for all of these on the same day, you will find that you will most likely only be paid for the lowest reimbursing procedure.
4) If you do decide to do the patient a favor and perform 92132, 92133 and 92134 all on the same day, bill for the highest reimbursing procedure only.
5) If for some reason you do get paid for any of the above codes bilaterally or more than one of the above codes, this money will be taken back by the insurance company during a coding audit and will likely reduce the payable amount of future checks.
6) The above rules apply to Medicare only. Though other insurance companies generally follow the medicare reimbursement rules, each insurance company may have separate reimbursement policies that do not necessarily follow what is laid out here. It would be a good idea to call Provider Services of the insurance company you plan on billing to find out what their individual reimbursement policies are for the above codes.

If you don't want to worry about coding these yourself, CALL OPTICxPRESS TODAY and we will help you !

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