What is Coding. Basics of Coding and Billing for the Optometric Staff. Vision Plan vs. Health Insurance. Vision Plan vs.

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Basics of Coding and Billing

Basics of Coding and Billing

for the Optometric Staff

for the Optometric Staff

Jonathan Cargo, O.D. Cargoeyecare.com Jonathancargo@yahoo.com

What is Coding

What is Coding

„

„

A system of diagnosis and procedure codes to

A system of diagnosis and procedure codes to

describe an encounter, procedure, diagnostic

describe an encounter, procedure, diagnostic

test, or supplies provided to a patient.

test, or supplies provided to a patient.

„

„

Centers for Medicare & Medicaid Services (CMS)

Centers for Medicare & Medicaid Services (CMS)

„

„

National Correct Coding Initiative (NCCI)

National Correct Coding Initiative (NCCI)

„

„

Manual is updated annually.

Manual is updated annually.

„

„http://http://www.cms.hhs.gov/NationalCorrectCodInitEdwww.cms.hhs.gov/NationalCorrectCodInitEd//

Vision Plan vs. Health Insurance

Vision Plan vs. Health Insurance

„

„

Vision Plans

Vision Plans

„

„

Coverage for routine wellness examinations

Coverage for routine wellness examinations

„

„Some cover contact lens fitting servicesSome cover contact lens fitting services

„

„

May cover hardware

May cover hardware

„

„Contact lenses, frames and spectaclesContact lenses, frames and spectacles

„

„

Usually have a fixed amount that they contribute.

Usually have a fixed amount that they contribute.

„

„ Some may only be discounted plansSome may only be discounted plans

„

„

Usage is typically limited to once/ year

Usage is typically limited to once/ year

„

„

Frequently limit your coding ability

Frequently limit your coding ability

Vision Plan vs. Health Insurance

Vision Plan vs. Health Insurance

„

„

Health Insurance

Health Insurance

„

„

Covers medical eye conditions

Covers medical eye conditions

„

„Office VisitsOffice Visits

„

„Diagnostic TestingDiagnostic Testing

„

„Surgical ProceduresSurgical Procedures

„

„Office ProceduresOffice Procedures

„

„May Cover Refractions?May Cover Refractions?

„

„

Subject to Co

Subject to Co

-

-

payments and deductibles

payments and deductibles

„

„

Usually has few restrictions on number of office visits

Usually has few restrictions on number of office visits

allowed.

allowed.

Health Insurance

Health Insurance

„

„ CoCo--payment (Copayment (Co--insurance)insurance)

„ Is the amount paid by the insured person each time a medical service is accessed

„ Sometimes this can be a fixed amount or a percentage of the allowed

amount.

„ Deductible

„ portion of any claim that is not covered by the insurance provider.

„

„ The deductible must be paid by the insured, before the benefits The deductible must be paid by the insured, before the benefits of the of the

policy can apply. policy can apply.

„

„ This payment should be collected from the patient at the time seThis payment should be collected from the patient at the time services are rvices are

delivered. delivered.

„

„ Most office visits that have a fixed coMost office visits that have a fixed co--pay the deductible does not apply to pay the deductible does not apply to

the office visit only the office visit only

„

„ Most percentage based coMost percentage based co--payments require a person must meet their payments require a person must meet their

deductible before any payment is made by the third party. deductible before any payment is made by the third party. „

„ The deductible amount usually starts over each calendar yearThe deductible amount usually starts over each calendar year

Coding Terminology

Coding Terminology

„

„ Procedure codesProcedure codes

„

„ CPTCPT--55

„

„Current procedural Terminology, 5Current procedural Terminology, 5ththEd.Ed. „

„ Diagnosis CodesDiagnosis Codes

„

„ ICDICD--99--CMCM

„

„International Classifications of Diseases, 9International Classifications of Diseases, 9ththRevision, Clinical ModificationsRevision, Clinical Modifications

„

„ ICDICD--10 on October 1, 201310 on October 1, 2013 „

„ Material CodesMaterial Codes

„

„ HCPCSHCPCS

„

„Health Care Procedures Coding SystemHealth Care Procedures Coding System „

„ Pharmaceutical CodesPharmaceutical Codes

„

„ AHFSAHFS

„

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Rules for billing

Rules for billing

„

„

The diagnosis (ICD

The diagnosis (ICD

-

-

9

9

-

-

CM) must relate to the

CM) must relate to the

procedure (CPT) code

procedure (CPT) code

„

„

Local Area Determination (LCD) will often tell you

Local Area Determination (LCD) will often tell you

what ICD

what ICD

-

-

9 code is allowed for a CPT code

9 code is allowed for a CPT code

„

„http://http://www.trailblazerhealth.comwww.trailblazerhealth.com „

„

The doctor should code every patient

The doctor should code every patient

„

„

The reason for the visit determines the coverage

The reason for the visit determines the coverage

„

„

Depends on the purpose of the examination rather

Depends on the purpose of the examination rather

than the ultimate diagnosis of the patient

than the ultimate diagnosis of the patient

s condition

s condition

Best Practice Ideas

Best Practice Ideas

„

„

Verify both health insurance and vision

Verify both health insurance and vision

plan prior to every office visit.

plan prior to every office visit.

„

„

Insurance plans frequently change

Insurance plans frequently change

„

„

Scan or copy image of insurance card and

Scan or copy image of insurance card and

photo ID.

photo ID.

„

„

Inform the patient what deductibles and

Inform the patient what deductibles and

co

co

-

-

pays will be collected prior to seeing

pays will be collected prior to seeing

the patient.

the patient.

Clean Claim

Clean Claim

„

„

Simply one that the third party payer

Simply one that the third party payer

processes automatically without human

processes automatically without human

review.

review.

„

„

This is done through standard coding and

This is done through standard coding and

using CPT and ICD

using CPT and ICD

-

-

9

9

„

„

Most plans have a set period of time that you

Most plans have a set period of time that you

have to submit a clean claim from the date of

have to submit a clean claim from the date of

service.

service.

CPT (procedure) Code Categories

CPT (procedure) Code Categories

„

„

92000 Ophthalmology Codes

92000 Ophthalmology Codes

„

„

99000 Evaluation and Management Codes

99000 Evaluation and Management Codes

„

„

60000 Surgical Codes

60000 Surgical Codes

„

„

70000 Radiological Codes

70000 Radiological Codes

„

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Ways to Code Examinations

Ways to Code Examinations

„

„

S codes Routine Eye examinations

S codes Routine Eye examinations

„

„

92000 Examination Codes

92000 Examination Codes

„

„

Special

Special

Ophthalmogical

Ophthalmogical

Procedures

Procedures

„

„

99000 Evaluation and Management

99000 Evaluation and Management

„

„

Consultations

Consultations

What is a New Patient?

What is a New Patient?

„

„

A new patient is one who has not received any

A new patient is one who has not received any

professional service from any doctor who

professional service from any doctor who

belongs to the same group practice within 3

belongs to the same group practice within 3

years.

years.

Wellness Examination

Wellness Examination

„

„

S codes are Level II HCPSC codes

S codes are Level II HCPSC codes

„

„

S0620

S0620

New patient routine

New patient routine

Ophthalmological

Ophthalmological

examination with refraction

examination with refraction

„

„

S0621

S0621

Established patient routine

Established patient routine

Ophthalmological

Ophthalmological

examination with refraction

examination with refraction

„

„

Texas Medicaid is one the first major payer to

Texas Medicaid is one the first major payer to

recognize this code.

recognize this code.

„

„Medicare does not reimburse for wellness examsMedicare does not reimburse for wellness exams

„

„Many Vision plans have not yet adopted this codeMany Vision plans have not yet adopted this code

General

General

Ophthalmological

Ophthalmological

Examination Codes

Examination Codes

„

„

Comprehensive

Comprehensive

Ophthalmological

Ophthalmological

Exam

Exam

„

„

92004

92004

-

-

New Patient

New Patient

„

„

92014

92014

-

-

Established patient

Established patient

„

„

Intermediate

Intermediate

Ophthalmological

Ophthalmological

Exam

Exam

„

„

92014

92014

New Patient

New Patient

„

„

92012

92012

Established Patient

Established Patient

Comprehensive

Comprehensive

Ophthalmolgical

Ophthalmolgical

Services(92004)

Services(92004)

A level of service in which a general evaluation of the complete

A level of service in which a general evaluation of the completevisual visual system is made

system is made

„

„

What

What

s required

s required

„ „

History

History

„

„

General medical observation

General medical observation

„

„

External and internal

External and internal

Opthalmoscopic

Opthalmoscopic

examination

examination

„

„

Gross visual fields

Gross visual fields

„

„

Basic sensory motor examination

Basic sensory motor examination

„

„

These definitions are not at strict as E/M codes

These definitions are not at strict as E/M codes

„

„Please note Refraction is not included in this definition.Please note Refraction is not included in this definition.

Intermediate

Intermediate

Ophthalmological

Ophthalmological

Services (92014)

Services (92014)

„

„

Describes a level of service pertaining to the evaluation

Describes a level of service pertaining to the evaluation

of a new or existing condition complicated with a new

of a new or existing condition complicated with a new

diagnostic or management problem not necessarily

diagnostic or management problem not necessarily

relating to the primary diagnosis

relating to the primary diagnosis

„

„HistoryHistory

„

„General medical observationGeneral medical observation

„

„External ocular and External ocular and adnexaladnexalexamination examination

„

„Other diagnostic procedures as indicatedOther diagnostic procedures as indicated

„

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Evaluation and management codes

Evaluation and management codes

„

„ E/M Codes can also be used to describe an eye examinationE/M Codes can also be used to describe an eye examination

„

„ More and better documentation is required for the 99000 codesMore and better documentation is required for the 99000 codes

„

„ Three components of E/M codes are Three components of E/M codes are

„

„ HistoryHistory

„

„ ExaminationExamination

„

„ Decision makingDecision making

„

„ New Patient: New Patient:

„

„99201, 99202, 99203, 99204, 9920599201, 99202, 99203, 99204, 99205

„

„ Established PatientEstablished Patient

„

„99211, 99212, 99213, 99214, 9921599211, 99212, 99213, 99214, 99215

Evaluation and management codes

Evaluation and management codes

„ „

History

History

„

„

Chief Complaint

Chief Complaint

„

„A concise statement describing the symptoms, problem, condition,A concise statement describing the symptoms, problem, condition,

diagnosis, physician recommended return, or other factor that is diagnosis, physician recommended return, or other factor that isthe the reason for the encounter, usually stated in the patients words. reason for the encounter, usually stated in the patients words. „

„Medical insurance also covers ongoing examinations or treatment Medical insurance also covers ongoing examinations or treatment for for

existing conditions. existing conditions. „

„History of present Illness (HPI)History of present Illness (HPI)

„

„Is a chronological description of the development of the patientIs a chronological description of the development of the patient’’s s

present illness from the first sign or symptom present illness from the first sign or symptom „

„There are eight areas and two levels of a HPI history There are eight areas and two levels of a HPI history

„

„4 or more then you have a high level of history 4 or more then you have a high level of history

„

„Extended HPIExtended HPI

„

„Less than 4 elements then you have a brief HPI Less than 4 elements then you have a brief HPI

„

„Brief HPI Brief HPI

E/M Coding: HPI Elements

E/M Coding: HPI Elements

No, Headache, Nausea No, Headache, Nausea Are there associated symptoms?

Are there associated symptoms? Associated

Associated symptoms symptoms

Short term, long term Short term, long term How long has the problem been

How long has the problem been present? present? Timing Timing Intermittent, Constant Intermittent, Constant How long does the problem last?

How long does the problem last? Duration

Duration

Distance, Near, Both Distance, Near, Both Is it worse at any distance?

Is it worse at any distance? Modifying

Modifying factors factors

Mild, Moderate, Severe Mild, Moderate, Severe How severe is the problem?

How severe is the problem? Severity

Severity

Sudden or gradually Sudden or gradually Did the problem occur?

Did the problem occur? Context

Context

Vision Loss or Blur Vision Loss or Blur Does the problem cause?

Does the problem cause? Quality

Quality

Right; Left; Both Right; Left; Both Which eye has a problem?

Which eye has a problem? Location Location

Response

Response

Question

Question

HPI

HPI

Area

Area

Evaluation and management codes

Evaluation and management codes

„

„

History

History

„

„Past, Family and Social History (PFSH)Past, Family and Social History (PFSH)

„

„There are two levels of PFSHThere are two levels of PFSH

„

„Review of the area directly related to the problemReview of the area directly related to the problem

„

„Pertinent Pertinent PFSHPFSH

„

„Highest level = 2 or more elements Highest level = 2 or more elements

„

„Complete Complete PFSHPFSH

„

„For a new patient you must document all three areas.For a new patient you must document all three areas.

„

„Review of Systems (ROS)Review of Systems (ROS)

„

„Review of systems has three levelsReview of systems has three levels

„

„Review of one system = Review of one system = Problem PertinentProblem Pertinent

„

„Review of 2-Review of 2-9 systems = 9 systems = ExtendedExtendedROSROS

„

„Review of 10 or more systems = Review of 10 or more systems = CompleteCompleteROS ROS

„

„It is not enough to make the statement It is not enough to make the statement ““All systems NegativeAll systems Negative””

What are the Systems?

What are the Systems?

„

„

Constitutional

Constitutional

„

„

Eyes

Eyes

„

„

Ears, Nose, Mouth,

Ears, Nose, Mouth,

Throat

Throat

„ „

Cardiovascular

Cardiovascular

„ „

Respiratory

Respiratory

„ „

Gastrointestinal

Gastrointestinal

„ „

Genitourinary

Genitourinary

„ „

Musculoskeletal

Musculoskeletal

„

„

Integumentary

Integumentary

(skin)

(skin)

„ „

Neurological

Neurological

„ „

Psychiatric

Psychiatric

„ „

Endocrine

Endocrine

„

„

Hematological (blood)/

Hematological (blood)/

Lymphatic

Lymphatic

„

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Classification of History

Classification of History

Complete Complete Complete Complete Extended Extended Comprehensive Comprehensive Pertinent Pertinent Extended Extended Extended Extended Detailed Detailed N/A N/A Problem Pertinent Problem Pertinent Brief Brief Expanded Expanded Problem Focused Problem Focused N/A N/A N/A N/A Brief Brief Problem focused Problem focused PFSH PFSH ROS ROS HPI HPI Type of History Type of History

Evaluation and management codes

Evaluation and management codes

„

„

Examination

Examination

„

„

Problem focused

Problem focused

„

„

1

1

-

-

5 examination elements

5 examination elements

„

„

Expanded problem focused

Expanded problem focused

„

„

6 or more examination elements

6 or more examination elements

„

„

Detailed examination

Detailed examination

„

„

9 or more examination elements

9 or more examination elements

„

„

Comprehensive examination

Comprehensive examination

„

„

All elements

All elements

Examination Elements

Examination Elements

„

„ Visual AcuityVisual Acuity

„

„ Gross visual field testing by confrontationGross visual field testing by confrontation

„

„ Ocular motility including primary gaze alignmentOcular motility including primary gaze alignment

„

„ Inspection of bulbar and Inspection of bulbar and palpebralpalpebralconjuntivaconjuntiva

„

„ Examination of ocular Examination of ocular adnexaeadnexae(area around the eye)(area around the eye)

„

„ Examination of pupils and irises including shape, direct and conExamination of pupils and irises including shape, direct and consensual reaction, size, and sensual reaction, size, and morphology

morphology

„

„ Slit lamp examination of the corneas including epithelium, Slit lamp examination of the corneas including epithelium, stromastroma, endothelium, and tear , endothelium, and tear film

film

„

„ Slit lamp examination of the anterior chambers, including depth,Slit lamp examination of the anterior chambers, including depth,cells, and flare. cells, and flare.

„

„ Slit lamp examination of the lenses including clarity, anterior Slit lamp examination of the lenses including clarity, anterior and posterior capsule, cortex, and posterior capsule, cortex,

and nucleus

and nucleus. . „

„ Measurement of intraocular pressuresMeasurement of intraocular pressures

„

„ Unless contraindicated, Unless contraindicated, ophthalmoscopicophthalmoscopicexamination through dilated pupils of optic discs examination through dilated pupils of optic discs including size, C/D Ratio, appearance, and nerve fiber layer

including size, C/D Ratio, appearance, and nerve fiber layer

„

„ Unless contraindicated, Unless contraindicated, ophthalmoscopicophthalmoscopicexamination through dilated pupils of posterior examination through dilated pupils of posterior segments including retina and vessels

segments including retina and vessels

„

„ Brief assessment of mental status including orientation to time,Brief assessment of mental status including orientation to time,place and personplace and person

„

„ Brief assessment of mental status including mood and affect.Brief assessment of mental status including mood and affect.

E&M: Medical Decision Making

E&M: Medical Decision Making

High

High

Extensive

Extensive

Extensive

Extensive

High High Complexity Complexity

Moderate

Moderate

Moderate

Moderate

Multiple

Multiple

Moderate Moderate Complexity Complexity

Low

Low

Limited

Limited

Limited

Limited

Low Complexity Low Complexity

Minimal

Minimal

Minimal

Minimal

Minimal

Minimal

Straightforward Straightforward Risk of Risk of complication complication and/or and/or morbidity or morbidity or mortality mortality Amount Amount and/or and/or complexity of complexity of data to be data to be reviewed reviewed Number of Number of diagnoses or diagnoses or management management options options Type of decision Type of decision making making

E & M coding: New Patient

E & M coding: New Patient

3 Elements must be met or exceeded

3 Elements must be met or exceeded

High Complexity High Complexity Comprehensive Comprehensive Comprehensive Comprehensive

99205

99205

Moderate Moderate Complexity Complexity Comprehensive Comprehensive Comprehensive Comprehensive

99204

99204

Low Complexity Low Complexity Detailed Detailed Detailed Detailed

99203

99203

Straight Forward Straight Forward Expanded P.F. Expanded P.F. Expanded P.F. Expanded P.F.

99202

99202

Straight Forward Straight Forward Problem Problem Focused Focused Problem Problem Focused Focused

99201

99201

Decision making Decision making Exam Exam History History

E & M coding: Established Patient

E & M coding: Established Patient

2 Elements must be met or exceeded

2 Elements must be met or exceeded

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E&M Examples

E&M Examples

„

„

Established patient who has a comprehensive history a

Established patient who has a comprehensive history a

comprehensive exam and moderate decision making

comprehensive exam and moderate decision making

„

„9921599215

„

„

New patient has a comprehensive history, a detailed

New patient has a comprehensive history, a detailed

exam and straightforward medical decision making.

exam and straightforward medical decision making.

„

„9920299202

„

„

An established patient has a comprehensive history, a

An established patient has a comprehensive history, a

detailed exam and straightforward medical decision

detailed exam and straightforward medical decision

making

making

„ „9921499214

Surgical codes

Surgical codes

„

„

You cannot bill for an office visit on the same

You cannot bill for an office visit on the same

day as surgical code using the same diagnosis.

day as surgical code using the same diagnosis.

„

„

You can however bill if there is a significantly

You can however bill if there is a significantly

separate diagnosis for each procedure

separate diagnosis for each procedure

„

„

Surgical codes usually have a global period that

Surgical codes usually have a global period that

includes follow up care.

includes follow up care.

„

„

Example:

Example:

Punctal

Punctal

plugs = 10 days

plugs = 10 days

„

„

The second procedure on the same day is

The second procedure on the same day is

always reimbursed at 50% of the allowed

always reimbursed at 50% of the allowed

amount.

amount.

Special

Special

Ophthalmological

Ophthalmological

Services

Services

„

„ Describes services in which a special evaluation of part of the Describes services in which a special evaluation of part of the visual system visual system

is made, which goes beyond the services included under general is made, which goes beyond the services included under general ophthalmological

ophthalmologicalservices.services. 92015 Refraction

92015 Refraction 92020 Gonioscopy92020 Gonioscopy 92060

92060 SensorimotorSensorimotor 92065 92065 OrthopticOrthoptictreatmenttreatment 92070 Fitting of contact lens for

92070 Fitting of contact lens for 92100 Serial Tonometry92100 Serial Tonometry disease

disease 92286 92286 SpecularSpecularMicroscopyMicroscopy 92225 Extended ophthalmoscopy

92225 Extended ophthalmoscopy 92250 Fundus Photography92250 Fundus Photography 92226 Subsequent

92226 Subsequent opthalmoscopyopthalmoscopy92285 External Photography92285 External Photography 92082 Intermediate VF

92082 Intermediate VF 92135 Scanning Laser 92135 Scanning Laser OphthOphth. . 92083 Threshold VF

92083 Threshold VF 92283 Color Vision exam92283 Color Vision exam 92140 Provocative Glaucoma test

92140 Provocative Glaucoma test

Consultations

Consultations

„

„

A consultation is a type of service provided by a

A consultation is a type of service provided by a

physician whose opinion or advice regarding E&M of a

physician whose opinion or advice regarding E&M of a

specific problem is requested by another physician or

specific problem is requested by another physician or

other appropriate source. There must be a report back

other appropriate source. There must be a report back

to the requesting physician or other appropriate source.

to the requesting physician or other appropriate source.

„

„

Three types of consultations codes

Three types of consultations codes

„

„Office Office

„

„9924199241--9924599245 „

„Initial inpatientInitial inpatient

„

„9925199251--9925599255 „

„FollowFollow--up inpatientup inpatient

„

„9926199261--9926599265

Consultation: Office

Consultation: Office

99241

99241

-

-

99245

99245

„

„

These codes are used to report consultations provided in

These codes are used to report consultations provided in

the physician

the physician

s office when another physician sends a

s office when another physician sends a

patient to your office for a specific medical sign or

patient to your office for a specific medical sign or

symptoms.

symptoms.

„

„You must have a written request from the physician requesting a You must have a written request from the physician requesting a consultation from you.

consultation from you.

„

„You must send a letter back to the referring physicianYou must send a letter back to the referring physician

„

„The consultation code can only be used on the first visit The consultation code can only be used on the first visit

„

„Follow up visits in the consultantFollow up visits in the consultant’’s office after the initial visits s office after the initial visits

should be coded using establish E&M coding. should be coded using establish E&M coding.

„

„CMS has eliminated the use of these codes as of Jan. 1, 2010.CMS has eliminated the use of these codes as of Jan. 1, 2010.

„

„Private insurance usually follows. Private insurance usually follows.

Modifier Codes

Modifier Codes

„

„ Modifier Codes indicate a unusual services, multiple procedures,Modifier Codes indicate a unusual services, multiple procedures,surgical cosurgical co--management, and break down management, and break down procedures into their components.

procedures into their components.

„

„ 22: Greater than normal service22: Greater than normal service

„

„ 25: Significant, separate identifiable E&M service by same pro25: Significant, separate identifiable E&M service by same provider on the same day vider on the same day

„

„ 26: Professional component26: Professional component

„

„ 50: Bilateral procedure50: Bilateral procedure

„

„ 51: Multiple procedures performed on the same day51: Multiple procedures performed on the same day

„

„ 52: Reduced services52: Reduced services

„

„ 55: Post operative management only55: Post operative management only

„

„ 56: Pre operative management only 56: Pre operative management only

„

„ 59: Significant, separate identifiable procedure by same provi59: Significant, separate identifiable procedure by same provider on the same dayder on the same day

„

„ TC: Technical ComponentTC: Technical Component

„

„ RT: RightRT: Right

„

„ LT: LeftLT: Left

„

„ E1: Right Superior Eye LidE1: Right Superior Eye Lid

„

„ E2: Right Inferior Eye LidE2: Right Inferior Eye Lid

„

„ E3: Left Superior Eye LidE3: Left Superior Eye Lid

„

„ E4: Left Inferior Eye Lid E4: Left Inferior Eye Lid

„

(7)

Bilateral

Bilateral

vs

vs

Unilateral

Unilateral

„

„ Unilateral codesUnilateral codes

„

„ Reimburse per eyeReimburse per eye

„

„ You could perform on just one eyeYou could perform on just one eye

„

„ If you perform on both eyes you could use the modifier (50)If you perform on both eyes you could use the modifier (50)

„

„Better option is to list the procedure on two lines and indicateBetter option is to list the procedure on two lines and indicateRT and LFRT and LF

„

„Example: Scanning Laser Example: Scanning Laser OphthalmoscopyOphthalmoscopy9213592135

„

„ Bilateral codesBilateral codes

„

„ Are designed to be performed on both eyesAre designed to be performed on both eyes

„

„ If you only perform it on one eye then your such you a 52 modifiIf you only perform it on one eye then your such you a 52 modifier er ––

reduced services to indicate only one eye reduced services to indicate only one eye

„

„ Example: Example: FundusFundusPhotos –Photos –9225092250 „

„ Unilateral or BilateralUnilateral or Bilateral

„

„ You would code it and be reimbursed the same if you perform the You would code it and be reimbursed the same if you perform the

procedure on one or two eyes. procedure on one or two eyes.

„

„ Example: Threshold Visual Field Example: Threshold Visual Field --9208392083

Components

Components

„

„

Most diagnostic procedures can be broken down

Most diagnostic procedures can be broken down

into their components using modifiers.

into their components using modifiers.

„

„

TC

TC

Technical component.

Technical component.

„

„

Reimbursing the cost of the equipment

Reimbursing the cost of the equipment

„

„

26

26

Professional component

Professional component

„

„

Reimburses the doctor

Reimburses the doctor

s interpretation of the data

s interpretation of the data

„

„

Without the modifiers then you receive

Without the modifiers then you receive

both components

both components

Diagnosis Codes: ICD

Diagnosis Codes: ICD

-

-

9

9

-

-

CM

CM

„

„ The first diagnosis code you list should be for the chief complaThe first diagnosis code you list should be for the chief complaint int that brought the patient into your office.

that brought the patient into your office.

„

„ Use the exact code for each diagnosis.Use the exact code for each diagnosis.

„

„ Code the patientCode the patient’’s condition to the highest degree of certainty for s condition to the highest degree of certainty for that appointment

that appointment

„

„ You may report treatments as many times as you provide them for You may report treatments as many times as you provide them for a chronic condition that your are treating on an ongoing basis.

a chronic condition that your are treating on an ongoing basis.

„

„ When coding for a postoperative diagnosis that is different fromWhen coding for a postoperative diagnosis that is different from that given prior to surgery, code for the postoperative diagnosi

that given prior to surgery, code for the postoperative diagnosis.s.

„

„ Example Example psuedophakiapsuedophakia „

„ Supply a code for any coSupply a code for any co--existing conditions that require or affect existing conditions that require or affect patient care at the time of the patient

patient care at the time of the patient’’s appointment. s appointment.

Best Practice Ideas

Best Practice Ideas

„

„

Never record in a patient

Never record in a patient

s chief complaint

s chief complaint

that they are there for a

that they are there for a

Routine eye

Routine eye

exam

exam

or

or

Needs new contacts/glasses

Needs new contacts/glasses

.

.

„

„

Always record a patient

Always record a patient

s complaint in their

s complaint in their

words.

words.

„

„

Example: Blurred vision, eye pain, vision distortion

Example: Blurred vision, eye pain, vision distortion

„

„

Appointments should also be classified by

Appointments should also be classified by

type of service

type of service

„

„

Comprehensive examination

Comprehensive examination

Not RV

Not RV

Diagnosis Codes: ICD

Diagnosis Codes: ICD

-

-

9

9

-

-

CM

CM

„

„

Codes are either 3,4,or 5 digits.

Codes are either 3,4,or 5 digits.

„

„

3 digit coding is very general

3 digit coding is very general

„

„

373 = Inflammation of eyelids

373 = Inflammation of eyelids

„

„

4 digit coding increasing specificity

4 digit coding increasing specificity

„

„

373.0 =

373.0 =

Blepharitits

Blepharitits

„

„

5 digit coding is very specific

5 digit coding is very specific

„

„

373.01 =

373.01 =

Uclerative

Uclerative

blepharitis

blepharitis

Diagnosis Codes: ICD

Diagnosis Codes: ICD

-

-

9

9

-

-

CM

CM

„

„ Infections and parasitic diseasesInfections and parasitic diseases

„ „ 001001--139.8139.8 „ „ NeoplasmsNeoplasms „ „ 140140--239.9239.9 „

„ Endocrine, Nutritional, Metabolic, ImmunityEndocrine, Nutritional, Metabolic, Immunity

„

„ 240240--279.9279.9

„

„ Blood and Blood forming OrgansBlood and Blood forming Organs

„

„ 280280--289.9289.9

„

„ Mental DisordersMental Disorders

„

„ 290290--319.9319.9

„

„ Nervous System and Sense OrgansNervous System and Sense Organs

„

„ 320320--389.9389.9

„

„ Disorders of the eye and Disorders of the eye and adnexaadnexa

„

„360360--379.9379.9

„

„ Circulatory SystemCirculatory System

„

„ 390390--459.9459.9

„

„ Respiratory SystemRespiratory System

„

„ 460460--519.9519.9

„

„ Digestive SystemDigestive System

„

„ 520520--579.9579.9

„

„ Genitourinary SystemGenitourinary System

„

„ 580580--629.9629.9

„

„ Complications of Pregnancy, Childbirth and Complications of Pregnancy, Childbirth and Puerperium

Puerperium

„

„ 630630--679.9679.9

„

„ Skin and Subcutaneous TissueSkin and Subcutaneous Tissue

„

„ 680680--709.9709.9

„

„ MuscloskeletalMuscloskeletalSystem and connective tissueSystem and connective tissue

„

„ 710710--739.9739.9

„

„ Congenital anomaliesCongenital anomalies

„

„ 740740--759.9759.9

„

„ Conditions in the Conditions in the perinatalperinatalperiodperiod

„

„ 760760--779.9779.9

„

„ Symptoms, Signs and illSymptoms, Signs and ill--Defined ConditionsDefined Conditions

„

„ 780780--799.9799.9

„

„ Injury and PoisoningInjury and Poisoning

„

(8)

ICD

ICD

-

-

9 V

9 V

-

-

Codes

Codes

„

„ Classification is provided to deal with the occasions when Classification is provided to deal with the occasions when circumstances other than a disease or injury classifiable to

circumstances other than a disease or injury classifiable to

categories are recorded as

categories are recorded as ““diagnosesdiagnoses””or or ““problems.problems.””

„

„ When a person who is not sick encounters health services for a pWhen a person who is not sick encounters health services for a purposeurpose

„

„ Organ or tissue donorOrgan or tissue donor

„

„ Prophylactic vaccinationProphylactic vaccination

„

„ Discuss a problem which is in itself not a problemDiscuss a problem which is in itself not a problem

„

„V65.5 Normal ExamV65.5 Normal Exam „

„ When a person with a disease or injury encounters the health caWhen a person with a disease or injury encounters the health care re

system for treatment of that disease or injury system for treatment of that disease or injury

„

„ Dialysis for renal diseaseDialysis for renal disease

„

„ Chemotherapy for malignancyChemotherapy for malignancy

„

„ When circumstances are present which influences the personWhen circumstances are present which influences the person’’s health s health

status but is not itself a current illness or injury. status but is not itself a current illness or injury.

„

„ V43.1 V43.1 PseudophakiaPseudophakia

„

„ V67.51 Meds with Ocular toxicityV67.51 Meds with Ocular toxicity

ICD

ICD

-

-

9 E Codes

9 E Codes

„

„

Classification system of environmental

Classification system of environmental

events, circumstances, and conditions as

events, circumstances, and conditions as

the case of injury

the case of injury

„

„

Must be used in addition the diagnosis code

Must be used in addition the diagnosis code

„

„

E800

E800

-

-

E999.9

E999.9

HCPCS Material V

HCPCS Material V

-

-

Codes

Codes

„

„

Are also used to describe products

Are also used to describe products

optometrists dispense

optometrists dispense

„

„

V2020

V2020

-

-

V2025 Frames

V2025 Frames

„

„

V2100

V2100

-

-

V2499 Spectacle Lenses

V2499 Spectacle Lenses

„

„

V2500

V2500

-

-

V2599 Contact Lenses

V2599 Contact Lenses

„

„

V2600

V2600

-

-

V2615 Low Vision Devices

V2615 Low Vision Devices

„

„

V2623

V2623

-

-

V2632 Surgical supplies

V2632 Surgical supplies

„

„

V2700

V2700

-

-

V2799 Spectacle Lens upgrades

V2799 Spectacle Lens upgrades

Claim Submission

Claim Submission

„

„

CMS 1500 form

CMS 1500 form

„

„

Paper form

Paper form

„

„Mailed or faxed inMailed or faxed in

„

„Medicaid requires that it must be typed and cannot be foldedMedicaid requires that it must be typed and cannot be folded „

„

Web submission

Web submission

„

„Specific to a single payer usuallySpecific to a single payer usually

„

„No special forms or accounts requiredNo special forms or accounts required „

„

Electronic clearing house

Electronic clearing house

„

„scrubs, formats and submits claims in realscrubs, formats and submits claims in real--time to hundreds time to hundreds of insurance companies for payment.

of insurance companies for payment.

„

„Uses electronic Payer IDsUses electronic Payer IDs

Cataract and Refraction

(9)

Punctal

(10)
(11)
(12)
(13)
(14)

Figure

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References

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Related subjects :