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 !

CLICK HERE TO CONTACT OPTICXPRESS!

Optometric Billing-Choose Office Ally as Your Clearinghouse...or opticXpress..Which is Also a Clearinghouse, And We Use Office Ally Anyway!

When it comes to submitting your medical claims to the insurance company, there is no better place to turn for EVERY optometric practice than office ally. Yes, I know you want to use vision web cause VSP/Eyefinity owns them and you think you have too. DUMB IDEA. Not only does it cost you money (office ally is free so that is a no-brainer) it is incredibly useless in terms of getting your reports back like EOB's/ERA's or correcting claims. Office Ally makes this process, easy, simple and intuitive. It is easy to correct and resubmit corrected claims and downloading and converting remittance advises/EOB's is a breeze. Also, Eyefinity owns officemate and officemate DOESN'T EVEN USE EYEFINITY TO RETRIEVE/IMPORT ERA'S, THEY USE GATEWAY EDI (ALSO, A STUPID AND EXPENSIVE SOLUTION, BUT THAT IS AN ENTIRE POST UNTO ITSELF) SO THAT SHOULD GIVE YOU AN IDEA AS TO HOW NON-USER FRIENDLY THE VISIONWEB SOLUTION IS. 

The following was posted on Office Ally's website today, and I agree with it 100%:

"False Accusations by CompetitorsPosted on: Thursday, January 30, 2014

Office Ally does not have plans to start charging for services that are currently free. Office Ally will continue to allow its clients to submit claims to participating payers electronically FREE OF CHARGE just as we always have. 

When you are at the top in your field, some competitors resort to deceptive ploys and outright lies in an attempt to entice customers to come on board with them. Recently, a competitor of Office Ally sent out marketing materials falsely claiming that Office Ally is telling its clients that we will start charging for clearinghouse services that are currently free. This could not be farther from the truth! 

We want to reassure you that these made-up claims are unfounded and just plain wrong. This is merely an unprofessional attempt by a competitor to scare you into using their services. 

We appreciate your business and thank you for your loyalty!"

YOU WOULD NEVER, NEVER,EVER SEE GATEWAY, VISIONWEB, OR APEX POST A PROMISE LIKE THAT, OFFICE ALLY STANDS BEHIND THIER PRODUCT, THEY ARE EASY TO WORK WITH AND THEY PROVIDE THE MOST CUTTING EDGE SUPPORT YOU WILL FIND ANYWHERE!

Did I mention that Office Ally is also FREE?!!! Do you really need another reason to choose them to submit your claims?

You can always choose opticXpress as your optometric billing service. We not only utilize Office Ally but we pass that savings on to you. CALL OPTICXPRESS TODAY!

CLICK HERE!

Optometry Billing-NEW CMS Form required April, 2014

The new CMS form will be required to submit claims beginning in April of this year. If you are a programmer, you can click this link to find mapping and layouts for the new form in order to update your software. If you are a biller, you should also click the link in order to familiarize yourself with the new form. 

For help understanding the new form, contact opticXpress today at 866-688-3335

or Click Here!

Optometry Billing-G8553...EXPIRED!

• G8553 code is no longer being accepted by Medicare (or other insurance companies for that matter), and will cause your claims to reject. This was the code to report E-rx incentives, which has been ended.

If you have been using this code and seeing claim rejections (espescially if you are using Gateway EDI) check for this proc code and Delete it then resubmit your claims as normal. 

For help with your optometry billing, Contact opticXpress today.

Click Here!

Optometric Billing-Windows XP not HIPPA Compliant as of April 8,2014

According to an email sent out by 1st physicians:

"As of 4-8-14 Windows XP will no longer be HIPPA compliant. Microsoft has announced that as of April 8, 2014, they will not release any security patches for the Windows XP operating system.  Without this support, Windows XP will be non-compliant with HIPAA.   This leaves just 12 weeks for you to replace any PC's on your network currently using Windows XP. Please note that this will not only affect health care, but also all business and government agencies, so it could result in a shortage of equipment available, or shipment delays."

Over the coming days, opticXpress will be listing links on our website where you can buy high quality, HIPPA compliant PC's. For now, you check out two that are sold in our amazon store by CLICKING HERE.

This is the opticXpress Hal500 fully HIPPA compliant PC

Call opticXpress today for help with replacing your non-compliant PC's.

(866)-688-3335 x1

Optometric Billing-Increase Reimbursement From Vision Insurances (VSP, DAVIS, EYEMED, SUPERIOR, ETC)

Yes. It's true. You can increase your reimbursement from vision plans that you participate with. There is no special trick to doing this. No special coding that you are required to learn. It's such a big secret, the vision company execs would probably kill me if I let this get out...but I'm gonna take the risk.

It's not hard to make this happen, in fact, it's actually quite simple. All you need is an individual working for you that is talented on the phone and the "cohones" to say "Cancel my contract"!!! Don't believe me?

Here at our clinic, we have successfully negotiated will ALL BUT ONE of our vision plans for an across the board increase of base pay for exams. Where we were receiving $38-$45 before for eye exams, we are now receiving $75 per exam FROM EACH COMPANY and many of the vision insurance companies have been gracious enough to raise our materials reimbursements as well, in most cases without us asking! The only company that didn't want to "play ball" was N.V.A and guess what? I just faxed them our notice of termination.

The bottom line is this: you don't have to continue to accept these low-ball reimbursements from vision plans! You can do something about it...especially if you are in a market where allot of employees utilize a particular plan or if it is a "high rent district". 

Not sure you are ready to try this on your own? Want some help from an optometric billing specialist ? Call us today and we can help you get paid what you deserve from vision insurance companies!

Call Toll Free: (866)688-3335 x1, ASK FOR ANDREW!