Ophthalmology Coding: Optimize Your Reimbursement

By Author: Julia Rose
Total Articles: 89
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Ophthalmology coding is the use of accurate alphanumeric codes to represent various diagnostic procedures and treatments in ophthalmology. Coders have to be well-versed in coding practices such as CPT, ICD, ICD-9 and HCPCS codes. Though the eyes cover a very small area of the body, the complications and diseases are diverse, and so, ophthalmology includes a number of sub-specialties to further refine the area of treatment. For coders, the minuteness of the sub-specialties and the varied treatments requires a very detailed understanding of the subject.


Take the example of ophthalmology coding for glaucoma treatment. There is a very less used category of codes - prolonged services. These codes are used only when a physician provides prolonged service which involves direct patient contact, stretched beyond the usual service in either the inpatient or outpatient setting. Prolonged service is reported in addition to other physician services. ...
... An appropriate code like +99354 should be selected for such procedures for the first hour, and +99355 for each additional 30 minutes.


Glaucoma practice uses many of the special ophthalmologic diagnostic tests on a daily basis listed in CPT, and you must capture these along with the office visit coding. If they are to be billed on the same day, review your carrier's compliance policies and confirm that you are using the proper CPT and ICD-9 codes. Always follow the evaluation and management (E&M) guidelines to be on the safe side, if you do not wish to attract audit.

The sole motive of all these precautionary measures is to understand how payers handle the codes to ensure that you do your ophthalmology coding accurately. You have to understand all the guidelines and go through real-life examples to get a clear picture. Last but not the least; go through the coding handbooks minutely.


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