🔹 1. Modifier 25 in Ophthalmology
Used when:
- E/M + procedure same day
🔹 2. Bilateral Billing (RT/LT vs 50)
- Some codes = bilateral by default
- Others require modifiers
🔹 3. Top Denial Reasons
- Missing medical necessity
- Incorrect diagnosis
- Bundling errors
🔹 4. Refraction Denials
- 92015 is non-covered
- Must collect from patient
🔹 5. Medical Necessity Documentation
Golden rule:
👉 “If it’s not documented, it’s not billable.”
🔹 6. Frequency Edits
Many tests have limits:
- OCT
- Visual fields
🔹 7. Audit Protection Tips
- Always include interpretation
- Link diagnosis properly
- Avoid overuse of high-level codes
