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    Wiki Using G2211 for eye care

    I believe this new HCPCS code would be billable by ECPs who provide long term care for chronic conditions. The question I get a firm answer to is what would be considered a serious/complex condition? Is it the patient with mild glaucoma or mild NPDR or would it apply to higher staged levels of...
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    Wiki G2212 in 2024

    I'll throw this out again. Does anyone know how the time to code the G2212 will be calculated in 2024 when a provider has qualified to use a 992x5 code, based upon time, in 2024? Will it calculate the same as 99417 or differently? Tom Cheezum, OD, CPC, COPC
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    Wiki Billing procedure vs E/M

    Many procedures are now bundled with the E/M visit. In eye care, we often have patients come in with a chief complaint of foreign body sensation after they get something in their eye. We do an exam to determine if there is a FB and, if it's present, remove it. For billing, we have done a E/M...
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    Wiki Billing G2212 in 2024

    I've heard that the time ranges for the 99202-99215 codes are being removed from those codes in 2024. I've also been told that Medicare is still going to allow providers to bill the G2212 code for prolonged services when coded with the 992x5 E/M codes when those are selected based on time...
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    Wiki G2212 question for 2024

    With the apparent changes occurring in the E/M code descriptors in 2024, can the G2212 code for "prolonged services" for the 992x5 codes still be used then? If so, what are the times used to calculate the number of units for this in light of the time ranges for the E/M codes being eliminated in...
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    Wiki 2024 E/M Descriptors

    Can anyone give me a document or source which has the text for the descriptors for the E/M (992x2 - 992x5) CPT codes for 2024? Tom Cheezum, CPC, COPC
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    Wiki 2024 E/M Time Changes

    I've read that the AMA is changing the time criteria for the E/M codes in 2024. Apparently, they are doing away with the present times and replacing them with a time "Threshold". I've not been able to find out what these thresholds for the new and established patient E/M codes. Can someone...
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    Wiki Question about billing medical student exams

    I know that since 2018 CMS has allowed medical students to document findings in an exam as they examine a patient, as long as they're supervised by a resident or attending physician, Therefore, what they document would be used to determine the E/M codes billed for the examine. Here's my...
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    Wiki Coding exams for medical students with time

    I know that since 2018 CMS has allowed medical students to document findings in an exam as they examine a patient, as long as they're supervised by a resident or attending physician, Therefore, what they document would be used to determine the E/M codes billed for the examine. Here's my...
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    Wiki ROS/Meds as part of audit

    I just wanted some thoughts on how much of the ROS should be documented under the 2021 E/M guidelines in regards to performing a "medically appropriate history and exam." This question is in regards to eye care exams. I feel that, for a comprehensive established patient exam, the provider...
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    Wiki Prolonged service codes

    Is Medicare still using the G2212 code instead of the 99417 this year? If so, are the times for the G2212 still different than for the 99417 like they were last year? Tom Cheezum, OD, CPC, COPC
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    Wiki Decision for surgery question

    I've had someone ask me a question about who gets credit for the decision for surgery, in respect to Moderate Risk for MDM. Here's the scenario: I'm an optometrist and see a patient for an eye exam with complaints of significant vision problems which, after examination, are due to cataracts. I...
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    Wiki Decision regarding surgery

    I've had someone ask me a question about who gets credit for the decision for surgery, in respect to Moderate Risk for MDM. Here's the scenario: I'm an optometrist and see a patient for an eye exam with complaints of significant vision problems which, after examination, are due to cataracts. I...
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    Wiki Par and Non Par Medicare question

    I don't think this is possible, but I'll ask. If a physician works at two different practices which are owned by different groups, can they be a Par MC provider at one office and a non Par provider at the second office? My guess is that they can't because even though each office has its own EIN...
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    Wiki Signature still needed for ROS and HPI?

    I realize that the new guidelines for the E/M office visit codes state that a "medically appropriate history and exam" is required now. A question for those of you who do auditing: Since anyHPI and ROS done for an exam may have been done entirely by staff, do you feel it's still necessary for...
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    Wiki Refraction and low vision exam questions.

    Refraction, 92015, has always been a code which isn't covered by Medicare and most other medical carriers. Since it's a procedure which has it's own CPT code and is reimbursed by direct patient payment to the provider, I don't believe it should be counted as part of the time when a provider uses...
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    Wiki Refraction time in low vision eye exams

    Refraction, 92015, has always been a code which isn't covered by Medicare and most other medical carriers. Since it's a procedure which has it's own CPT code and is reimbursed by direct patient payment to the provider, I don't believe it should be counted as part of the time when a provider uses...
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    Wiki Medicare participation at different practices?

    If a doctor works for different practices, and they are a Medicare provider at one practice, do they have to accept Medicare at all of the practices they work for? I'm talking about practices with different owners, not office locations.
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    Wiki 2021 Medicare PFS

    Has anyone seen the 2021 PFS which gives specific fees for the CPT codes? All I've been able to find is a schedule listing proposed RVUs for various codes.
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    Wiki Telemedicine coding webinar

    Not sure if this will be allowed but I thought I'd let everyone know that I have put together a telemedicine coding webinar which is available on line by demand. Even though I titled it for optometry, everything said would apply to ophthalmology as well. It discusses the 3 main code sets we may...
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    Wiki Aetna down coding

    Is anyone having trouble with Aetna automatically downcoding your E/M visit codes? I'm hearing that there have been so many complaints from OD offices about this that the AOA has lodged a formal complaint against Aetna. If you've had this problem, have you found a solution to stopping it or are...
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    Wiki 65435 denials

    Anyone having problem with denials for this code for corneal debridement? Usually done if a patient has a significant corneal abrasion to remove excess damaged corneal epithelium in order to promote healing of abrasion.
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    Wiki Charging for records audit

    I do consulting work on record keeping, billing and coding for optometry/ophthalmology. Recently, a couple of clients have asked me to do record audits for them. Is it best to charge a per record fee or an hourly rate for this type of service. If per chart, what would you recommend as the fee...
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    Wiki Risk table for MDM

    Does anyone have an optometry/ophthalmology specific risk table for MDM? Tom Cheezum, O.D., CPC, COPC
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    Wiki Audit tool

    Does anyone have a good E/M audit tool specific to optometry/ophthalmology that you're willing to share? Tom Cheezum, O.D., CPC, COPC
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    Wiki 99050 and 99058 codes for emergency visits

    We often see patient outside of normal office hours for ocular emergencies and would bill a 99050 in addition to the E/M or 92xxx code. If an emergency patient comes in during regular hours with an emergency and a doctor has to attend to them immediately, due to the nature of the injury, we...
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    Wiki 99024 and Gxxx5 codes for post op visits

    When coding for routine post op cataract surgery visits, you would normally use 99024 with a $0.00 charge. CMS proposed a HCPCS Level II G coding system where GXXX5 (per 10 minute increment) would probably be the most accurate code to record the time involved in the post op visits. I'm having...
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    Wiki New patient to provider or not

    A little different scenario in the new versus established patient definition: A doctor purchases the practice of another doctor of the same specialty. The practice, under the new owner, is now under a new group NPI number for his professional corporation. The new practice owner never saw any...
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    Wiki Post op visits after global periods are eliminated

    Supposedly, CMS is eliminating 10 day post op periods in 2017 and the 90 day post op periods in 2018. Does anyone know how we'll bill for post op visits after the global periods are eliminated? I assume we'd use the appropriate 99xxx code but will there be special modifiers to indicate that...
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