Do you feel like you learned enough about coding during residency or fellowship? For many ophthalmologists, coding is one of those real-world skills that does not fully come into focus until they are already in practice. Yet understanding the basics and knowing the common pitfalls can make a meaningful difference in appropriate reimbursement, documentation efficiency, and compliance.
At Real World Ophthalmology (RWO), we often hear from trainees and early-career ophthalmologists that coding can feel confusing, overwhelming, and easy to overlook during training. That is why practical sessions at RWO meetings are designed to bring these topics into the open. By learning directly from experienced ophthalmologists, early-career surgeons can gain the kinds of real-world pearls that are often not taught in textbooks or formal lectures.
For this RWO Corner column, we asked experts in retina, glaucoma, and cornea to share coding tips they wish more ophthalmologists knew. Their advice highlights a common theme across subspecialties: good coding starts with thoughtful documentation, clear medical necessity, and an understanding of how visits, imaging, and procedures are interpreted from a reimbursement and compliance standpoint.
Retina: Dr. Jayanth Sridhar
Tip #1: “Correct modifier use in the post-op period is critical for the busy retinal surgeon. Use Modifier 58 for procedures that represent planned or escalating levels of care. Use Modifier 78 for unplanned procedures in the post-operative period. Use Modifer 79 for unrelated procedures in the post-operative period.”
Tip #2: “It is important to understand which surgical retina codes are bundled (ie, redundant with one another). For example, CPT 67108 (vitrectomy for retinal detachment repair) includes focal endolaser, so it cannot be combined with CPT 67039 (vitrectomy with focal endolaser). On the other hand, one could bill for both CPT 67108 and CPT 66986 (intraocular lens exchange) as the codes do not overlap.”
Glaucoma: Dr. Jonathan Tijierina and Dr. Adam Rothman
Tip #1: “When coding for glaucoma clinic visits, generally recall that CPT 99204/99214 (E/M) reimburses more than CPT 92004/92014 (Eye), which in turn reimburses more than CPT 99203/99213. Typically, the E/M code should be used if documentation meets all criteria, as the reimbursement is often higher for an equivalent level of service. Additionally, the G2211 modifier may be added to E/M codes for an additional 0.33 work RVU when you recommend ongoing/longitudinal patient care with yourself, your department, or your institution.”
Tip #2: “This tip refers to these less frequently employed codes: Gonioscopy 92020 (1-2 times per year), Pachymetry 76514 (1 time per patient), Corneal Hysteresis 92145 (1 time per year), and Serial Tonometry 92110 (varies, generally 1 time per year for diurnal fluctuation curve or, rarely, to establish treatment effect after a procedure, such as LPI). These codes can be used with varying intervals but are an essential part of the care of almost all glaucoma patients. As such, we should consider them when appropriate, as virtually every provider will use these sources of information in our decision making.”
Cornea: Dr. Neel S. Vaidya and Dr. Shivani Majmudar
Tip #1: “Corneal topography (CPT 92025) is one of the most useful images for a corneal specialist; I routinely get one on almost every one of my patients. Yet, it is only reimbursable when there's a clear medical indication documented in the chart—keratoconus, irregular astigmatism, post-keratoplasty surveillance, etc. It is necessary to couple the order to a specific diagnosis and to explain how the result will change management; using language such as “rule out” or “routine screening” is not sufficient. In my practice, there are many topographies that I perform that I do not bill for. Being judicious about repeatedly billing for imaging is important.”
Tip #2: “Before a toric IOL or limbal relaxing incision can be performed with cataract surgery for astigmatism management, the chart needs to independently justify the intervention. This can often go overlooked, as astigmatism management is typically a non-covered procedure that patients pay for out of pocket. However, documenting the magnitude and axis of astigmatism from an imaging modality and adding astigmatism as a diagnosis are crucially important to ensure that the procedure is justified.”
Final Thoughts
Coding may not be the most glamorous part of ophthalmology, but it is one of the most important real-world skills for building a sustainable, compliant, and efficient practice. Whether you are in retina, glaucoma, cornea, comprehensive ophthalmology, or another subspecialty, thoughtful documentation and an understanding of coding fundamentals can help support both patient care and practice success. OM
RWO Leadership Launchpad
As this column reminds us, success in ophthalmology requires more than clinical knowledge. That is why RWO is excited to launch the RWO Leadership Launchpad, a new mentorship and coaching program for early-career ophthalmologists. Participants will be coached in small, specialty-based groups and connected with mentors and peers who understand their goals. Applications are open now, and spots are limited. Apply today at RealWorldOphthalmology.com and continue growing with RWO—by physicians, for physicians.