The bottom line
Ophthalmology denials concentrate in three places: laterality on intravitreal injections, complex cataract cases documented in generic language, and premium IOL upgrades billed as though Medicare might cover part of the upgrade.
The premium IOL section is the one to read even if you skip everything else, because the conventional advice on it is wrong in three specific ways, including a code that is widely cited as the premium lens code and is actually the covered conventional lens.
What the full playbook covers
Solo subscribers read the full playbook. Here is what it contains.
- Definitions and frequently used terms
- Why this specialty bills differently
- Intravitreal injections
- Cataract surgery
- Premium IOLs, where the conventional advice is wrong
- NCCI Chapter 8
- Diagnostic imaging frequency
- The denial patterns you will actually see
- Practices that prevent the denial
- Frequently asked questions
- How we work on this at ROI
- Three things worth checking this week
- Sources