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Coding and Reimbursement

State specific seminars designed to enhance participants' coding competency
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Vital tools to assist you in coding correctly the first time.
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Visit the Academy Store for the lastest coding and reimbursement products!
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Reliable information equals appropriate payment
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Conquering ICD-10-CM

Prepare now for Oct 1, 2015 implementation.
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Test your coding competency; Take the Ophthalmic Coding Specialist exam!
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News from CMS

New! Dropless Cataract Surgery

Dec. 19, 2014

CMS provides clear guidance to carriers that periocular injections of combined anti-inflammatory drugs and antibiotics are never separately payable. They cite that there is increased frequency of billing for such injections, commonly referred to as “dropless” cataract surgery. Injection of a drug during a cataract extraction or other ophthalmic procedure is not separately reportable according to the transmittal. Injections are a part of the ocular surgery and are included as a part of the ocular surgery and the CPT codes used to report the surgical procedure. CMS also warns that physicians or facilities cannot circumvent packaged payments in the HOPD or ASC for these drugs by instructing beneficiaries to purchase and bring these drugs to the facility for administration.


Coding for Corneal Transplant Tissue

Dec. 19, 2014

CMS reiterates its long standing policy that corneal tissue is to be paid on a cost basis and not under the Outpatient Perspective Payment System. Facilities should bill separately based on the invoice using HCPCS code. The Academy and the Eye Bank Association of America (EBAA) have been hearing reports from around the country of some instances where such facility claims are being denied. The Academy and EBAA met with CMS this fall to request that they reaffirm their longstanding policy and reissue guidance to payers about paying based on cost reporting.


Physician Quality Reporting System (PQRS)

Physician Quality reporting System

The 2014 incentive payment is 0.5 percent. Visit the PQRS page for the latest updates.

Whether reporting via claims, registry, or cataract group measure, Academy/AAOE has all the resources you need to achieve the incentive payment and avoid future penalties.


E-Prescribing (eRx)

E-Prescribing (eRx)

The E-Prescribing program retired effective Jan. 1, 2014. Practices no longer need to report G8553 on their claim forms

ASC Coding Module

ASC Coding Module

Many ophthalmologists have ownership interests in ambulatory surgery centers (ASCs). It’s where a majority of ophthalmic surgical cases in the United States are performed. Unlike physician billing, very little information is available about ASC billing that is ophthalmology specific. That need prompted research and development of the ASC module: Complete Guide to Coding which is now available as a free member benefit.

Download the Complete Guide to Coding [PDF 444K]. 


Additional Coding Quick Links