Ophthalmology
Revenue Yield
Stop losing revenue on complex coding audits and modifier adjustments. Partner with Apex experts trained specifically in ophthalmology guidelines.
Common Billing Challenges in Ophthalmology
Practicing medicine requires your full focus. Unfortunately, navigating payer-specific guidelines, bundling edits, and coding specificity often causes clinical revenue to get delayed or written off.
Deciding between Eye Codes (920xx) and standard E/M Codes (992xx) for optimal reimbursement.
Accurate billing for bilateral procedures and expensive intravitreal injections (anti-VEGF).
High rates of prior authorization denials for diagnostic tests like OCT and visual fields.
Compliant Modifiers
Ophthalmology claims require precise documentation and correct modifiers to justify reimbursement under strict NCCI guidelines.
Bilateral procedure modifier indicating service was performed on both eyes.
Left eye modifier specifying anatomical location of procedure or drug.
Right eye modifier specifying anatomical location of procedure or drug.
Why General Billing Fails
- •Choosing sub-optimal billing codes (Eye vs. E/M) based on payer preferences
- •Failing to track drug wastage for premium intravitreal medication vials
- •Bilateral modifier errors resulting in 50% underpayment on surgeries
- •Missing authorizations for diagnostic optical coherence tomography (OCT)
Interactive Claim Pipeline
Click on each workflow phase to inspect our protocols, software rules, and certified check systems.
Drug Auth & Log Setup
Prior authorizing premium injections and diagnostics.
We secure prior authorization for Lucentis, Eylea, and Avastin injections, and track inventory closely to match billing records.
Phase Protocols
Frequently Asked Questions
Ready to Optimize Your Ophthalmology Yield?
Let us conduct a complimentary review of your billing records and codes to identify hidden leaks and contract underpayments.