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Ophthalmic Coding Specialist 2025

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Question: 1080

VUs are fixed amounts regardless of location and specialty

VUs are solely determined by the complexity of the surgical procedur ormed

VUs are adjusted based on GPCI, accounting for the cost of living an ice expenses in specific geographic areas

VUs are calculated only based on the provider’s historical billing patt wer: C

anation: RVUs are calculated using a formula that includes three ponents: the work RVU, the practice expense RVU, and the malpracti

which are then adjusted based on the GPCI to reflect regional differ st.

stion: 1081

characteristic finding would most likely be observed in a patient wit

In the context of the Medicare Physician Fee Schedule (MPFS), which of the following best describes how the relative value units (RVUs) are calculated for ophthalmic services, considering the geographical practice cost index (GPCI)?

R
R e
perf
R d
pract
R erns

Que

early-stage age-related macular degeneration during a fundus examination?

Subretinal neovascularization
Geographic atrophy
Drusen in the macula
Vitreous hemorrhage

Explanation: Drusen in the macula are early signs of age-related macular degeneration, indicating the beginning stages of this degenerative condition.

Question: 1082

ician plans to perform a YAG laser capsulotomy. What should be cod his procedure?

anation: The procedure for YAG laser capsulotomy is coded as 66821 h specifically addresses the treatment for posterior capsule opacificati

stion: 1083

role do "incident-to" services play in the billing of ophthalmic servic the MPFS, especially concerning non-physician providers?

After cataract surgery, a patient develops posterior capsule opacification. The phys ed

6
6
6
6

Que

Incident-to services are not applicable in ophthalmology
Incident-to billing allows non-physician providers to bill for services under the supervising physician’s NPI, provided certain criteria are met
Incident-to services can only be billed for procedures, not for evaluation and management services
Non-physician providers cannot bill under any circumstances in a physician’s practice

Explanation: Incident-to services enable non-physician providers to bill for certain services under the supervising physician’s NPI, allowing for expanded service provision under specific conditions.

tient is diagnosed with acute angle-closure glaucoma. Which mechani ving the iris and pupil contributes to this condition?

he iris obstructs aqueous humor outflow he pupil constricts excessively

he lens dislocates forward he vitreous body liquefies

anation: In acute angle-closure glaucoma, the peripheral iris obstructs cular meshwork, preventing aqueous humor from draining, leading to ased intraocular pressure and potential vision loss.

stion: 1085

tient diagnosed with retinoblastoma undergoes treatment but develops

T
T
T
T

Que

secondary tumor 10 years later. Which of the following secondary malignancies is most commonly associated with previous retinoblastoma?

Melanoma
Lymphoma
Osteosarcoma
Neuroblastoma

Explanation: Osteosarcoma is the most commonly associated secondary malignancy in patients who have been treated for retinoblastoma, particularly those with hereditary forms.

processing of visual information, which of the following best descri ignificance of the lateral geniculate nucleus in relation to the optic tra

he LGN is the final processing stage for visual information before it hes the optic tract.

he LGN serves as a relay and processing center that receives input fro tract and sends modified signals to the visual cortex.

he LGN has no functional relationship with the optic tract and operate pendently in visual processing.

he LGN primarily processes auditory signals and has minimal involve sual information relay.

anation: The lateral geniculate nucleus acts as a relay and processing er for visual information received from the optic tract, modifying sign re transmitting them to the visual cortex for further processing.

T
reac
T m the
optic
T s
inde
T ment

Question: 1087

A patient undergoes a fundus examination using a specialized imaging technique that captures detailed images of the retina. Which code should be reported for this diagnostic test?

led imaging essential for diagnosing retinal conditions.

stion: 1088

-year-old patient presents with a suspected diagnosis of primary open glaucoma. During the gonioscopy, the physician notes that the angle open but has a moderate amount of pigment deposition. Which of the wing findings would most likely be recorded during this examination?

lood vessels crossing the angle

narrow angle with appositional closure

pigmented trabecular meshwork with a normal Schwalbe's line resence of peripheral anterior synechiae

anation: In primary open-angle glaucoma, a wide open angle with pig sition indicates that the trabecular meshwork is functioning, but the

Explanation: Code 92250 is used for fundus photography, which provides detai

Que

B
A
A
P

pigment suggests a history of increased intraocular pressure. Normal Schwalbe's line further supports a diagnosis of open-angle glaucoma.

Question: 1089

A patient is diagnosed with diabetic retinopathy and has undergone laser treatment. During the follow-up, new retinal hemorrhages are discovered. What

is the appropriate diagnosis code for this follow-up visit?

A. H35.32 B. H36.0 C. E11.359 D. H36.9

anation: The correct code is E11.359, which indicates the presence of etic retinopathy with complications. The other codes do not include th etic context.

stion: 1090

tient with a traumatic cataract undergoes a combined procedure of cat ction and vitrectomy. Which coding approach would best reflect the plexity of this surgical encounter?

se separate codes for cataract and vitrectomy without modifiers se a bundled code for combined procedures

se the higher of the two procedure codes dd a modifier to the cataract code only

Que

U
U
U
A

Explanation: The best approach is to use a bundled code for combined procedures if available, as this accurately reflects the complexity and scope of the surgical encounter.

Question: 1091

amount of floaters and a dark shadow in their peripheral vision. Which condition should be suspected?

Uveitis
Cataracts
Glaucoma
wer: D

anation: The presence of floaters and a dark shadow (also known as a ain effect") in peripheral vision are classic signs of retinal detachment e the retina separates from the underlying tissue.

stion: 1092

onioscopy evaluation, the physician encounters a "double-hump" guration of the angle. What does this finding typically suggest about t nt's ocular condition?

seudoexfoliative glaucoma gmentary glaucoma
ngle-closure glaucoma rimary open-angle glaucoma

wer: A
Retinal Detachment Ans

Que

P
Pi
A
P

Explanation: The "double-hump" configuration seen during gonioscopy is suggestive of pseudoexfoliative glaucoma, where the exfoliative material can cause mechanical obstruction of the trabecular meshwork, leading to variations in angle appearance.

In coding for a comprehensive refraction exam, which additional test, if performed, would require the use of a separate code, such as 92065?

Que

A pa unde intra

3
3
3
3

Explanation: The correct codes are 366.26 for traumatic cataracts and 932.00 for the intraocular foreign body, accurately documenting the complexities involved.

Question: 1095

A patient presents with astigmatism and is considering laser surgery. What is a crucial factor to evaluate before proceeding with this type of surgical intervention?

Que

7
7
7
7

Explanation: Code 70543 is used for MRI of the brain with and without contrast and would be appropriate for evaluating an optic nerve tumor.

Question: 1097

cataracts. After surgical intervention, what is the appropriate coding for the condition during the post-operative visit?

A. H25.9 B. Q12.0 C. H26.009 D. H26.1

anation: Congenital cataracts are coded as Q12.0. The other codes do rately represent the congenital nature of the cataracts.

stion: 1098

pathway of light from the outside environment to the retina, which ture acts as the first refractive surface, and what is its primary functio

ornea; bending light to direct it toward the pupil ens; focusing light onto the retina

queous humor; maintaining pressure itreous body; stabilizing the retina

anation: The cornea is the first refractive surface that bends light as it

Que

C
L
A
V

enters the eye, directing it through the pupil toward the lens for further focusing onto the retina.

Question: 1099

follow-up services would require the use of a specific modifier to indicate that the service is unrelated to the surgical procedure?

Modifier 91
Modifier 25
Modifier 59
wer: D

anation: Modifier 24 is used to indicate that the follow-up service is ated to the surgical procedure performed earlier, allowing for separate ng for the visit.
Modifier 24 Ans

Expl unrel billi

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