The AOA’s coding experts offer guidance to support doctors and staff in providing the best possible patient care while ensuring accurate reimbursements are received.
Here are some recent questions posed to the experts and their answers.
I saw a new patient for an office visit. The patient reports seeing flashes and floaters. I dilated the patient and diagnosed an acute posterior vitreous detachment (PVD). I educated the patient and recommended a return visit in four weeks for a repeat dilated fundus exam. Does this qualify to report CPT 92004? How do I ensure I meet the requirement to initiate a “diagnostic and treatment program”?
You need to ensure that you maintain good documentation. You would typically meet the requirements for a 92004 based on what you provided for the patient, as your diagnostic plan was to dilate (make sure you write it in the orders) and the treatment plan was to return in one month with provision of education.
What is the code for MGD diagnosis?
The code set begins at H02.88 meibomian gland dysfunction of eyelid. For a fully updated listing of diagnosis codes, purchase the Codes for Optometry manual at the AOA Marketplace.
Where can I find code bundling edits?
AOA Coding Today is an online, comprehensive database that contains information in real time for CPT, ICD-10, and HCPCS coding and research. The website is tailored specifically to optometry, assisting doctors and staff in correct reimbursement and compliance, and has an easy-to-use code diagnosis ability based on region.
Utilize AOACodingToday as a free, member resource to assist you immediately with your coding questions.
Ask the coding experts
If you have any questions regarding Medical Records and Coding, please submit them by using the Coding Experts Submission Form and one of our coding experts will be in contact with you.
Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2024, the AOA continues to press for Congress to act on reforms that would give doctors of optometry an annual, permanent inflationary Medicare payment tied to the Medicare Economic Index.
The federal government and private payers are heavily scrutinizing the use of modifier -25. When used appropriately, it can help to ensure that patients receive appropriate treatment and that doctors of optometry are reimbursed appropriately for their service. If you believe a claim that includes modifier -25 was inappropriately denied, follow appropriate criteria when appealing.