Medical Billing for Ophthalmology

Medical Billing for Ophthalmology Procedures

Ophthalmology Medical BillingMPMR offers medical billing for ophthalmology and has expert coders for this specialty. Practices experience increased revenue and confidence knowing their billing is being handled with experience, expertise with full reporting in real time.

As with other medical specialties, ophthalmology has specified billing codes in order to ensure the billing process is as accurate as possible. For procedures, seve alphanumeric characters are used in order to create the correct billing information for the correct billing cycle.

Character Order for Ophthalmology Billing

The order of the characters as well as what they represent are as follows:

  • Character 1: Section, or the medical area under which the procedure falls
  • Character 2: Body System, or the system of the body on which the procedure is being performed
  • Character 3: Root Operation, which is the basic procedure being performed.
  • Character 4: Body Part or the specific part of the body on which the procedure is being performed
  • Character 5: Approach or how the procedure is being performed (i.e. open, percutaneous, endoscopic, etc.)
  • Character 6: Device, or any instruments that are used specifically for the procedure (i.e. monitoring devices, insertion devices, etc.).
  • Character 7: Qualifier, or any other important information that would distinguish the procedure from similar ones.

Ophthalmology Procedure Codes

Medical Billing for OphthalmologyWhen certain aspects of the procedure are not specified, such as a qualifier, this character is marked with a “Z.” This tells the billing software that a qualifier was not needed in this instance and the other six characters should have clearly defined the procedure.

For ophthalmology, codes are designated 08, which translates into a medical procedure having to do with the eye. When a patient goes in for a simple eye exam, the codes that are used are as follows: 08J0XZZ, 08J1XZZ, 08JJXZZ, 08JKXZZ, 08JL0ZZ or 08JLXZZ, and 08JM0ZZ or 08JJMXZZ.

These codes represent an inspection of the eye structure both left and right, the lenses both left and right, and the extraocular muscles both left and right. For the extraocular muscle inspection, the difference in coding is determined by the approach taken as either an open or external one.

Billing for Intraocular Pressure Release

For more complicated procedures, different codes are used. For excessive eye pressure, if a patient were to need to release his or her right eye due to some sort of pressure build-up, the code would be 08N0XZZ. This includes:

  • 08 -Indicates that the procedure is a medical procedure of the eye.
  • N – Denotes that the root operation is a release, which means that the eye must be released from an abnormal physical constraint either through cutting or by force.
  • 0 -Indicates that the right eye is the specific body party to which the procedure is trying to fix.
  • X – Shows that the approach is going to be external, which means that the eye will be released, most likely by using force.
  • ZZ – Indicates that there is no need for a device or an extra qualifier when coding this particular procedure. In other cases, a qualifier may be needed in order to provide the insurance company with more information, but in this case, it is not.

Conclusions

Billing for ophthalmology follows similar rules to billing for other medical specialties. Once the beginning of the code can be ascertained, finding the rest of the corresponding characters is made a lot easier. The pattern does not change when coding; it still fits into the seven-character Medical Billing Neurologypattern established by the ICD-10-PCS. The characters themselves along with their corresponding meanings will change depending on the type of procedure being performed.

Consult the ICD-10 to ensure that the billing codes are correct and up-to-date, otherwise, the billing process can be inaccurate and delayed. In order to assure accurate coding and correct billing cycles, using the manual and software for coding information is vital.

MPMR has expert certified coders for ICD-10 and ophthalmology medical billing, with significant experience with practices big and small. MPMR also offers credentialing and contracting services along with unparalleled customer service.

Call today to find out how your practice will benefit from the expert ophthalmology medical billing from MPMR!

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