Medical Coding for Medical Coding for OptometryOptometry

Alan Homestead ODAlan Homestead OD

Seattle WASeattle WAalan@accufee.comalan@accufee.com

Who?Who?

Private practice – SeattlePrivate practice – Seattle Pacific U 1980Pacific U 1980 I.H.S. – Apache Resv. AZI.H.S. – Apache Resv. AZ CAC NoridianCAC Noridian Director Billing & Coding – Power PracticeDirector Billing & Coding – Power Practice MBA FacultyMBA Faculty Columns – O.M., Rev Cor & CL, Ophth OfficeColumns – O.M., Rev Cor & CL, Ophth Office Creator - AccuFeeCreator - AccuFee

22

DISCLOSURESDISCLOSURES

The Power PracticeThe Power Practice AccuFee AccuFee Professional Practice SystemsProfessional Practice Systems Not employee of insurance or EHR Not employee of insurance or EHR

companycompany

33

INTRODUCTIONINTRODUCTION

All coding topics are fair gameAll coding topics are fair gameAll topics can be returned to All topics can be returned to All topics can be expandedAll topics can be expanded

All topics can be arguedAll topics can be argued

44

INTRODUCTIONINTRODUCTION

Rules differ by insurance, by MAC, by region – share.Rules differ by insurance, by MAC, by region – share.I may not agree with state expert or last speaker.I may not agree with state expert or last speaker.

Rules are vague.Rules are vague.““Don’t askDon’t ask”” rule makers unless you already know. rule makers unless you already know.

55

INTRODUCTIONINTRODUCTION

Assumption - you know nothingAssumption - you know nothing Repetition is the key to learning, will cover some Repetition is the key to learning, will cover some

topics more than oncetopics more than once Participate! The more you participate the better Participate! The more you participate the better

you rememberyou remember

66

SOURCE OF INFORMATIONSOURCE OF INFORMATION

OriginalOriginal CPT (Current Procedural Terminology – yearly)CPT (Current Procedural Terminology – yearly) ICD-9, 10 (International Classification of Disease) ICD-9, 10 (International Classification of Disease) LCDs (Local Coverage Determination)LCDs (Local Coverage Determination) NCDs (National Coverage Determination)NCDs (National Coverage Determination) NCCI (National Correct Coding Initiative)NCCI (National Correct Coding Initiative) DG (Documentation Guidelines 1995 & 1997)DG (Documentation Guidelines 1995 & 1997) Medical PolicyMedical Policy

77

SOURCE OF INFORMATIONSOURCE OF INFORMATION

OpinionOpinion Coding & Billing Articles in MagazinesCoding & Billing Articles in Magazines Online SourcesOnline Sources VendorsVendors AOA, AAOAOA, AAO Speakers/Authors - Be wary of what you hear, Speakers/Authors - Be wary of what you hear,

especially me.especially me. Final Decision = Auditor or JudgeFinal Decision = Auditor or Judge

88

SOURCE OF INFORMATIONSOURCE OF INFORMATION

RecommendationRecommendation CPT manual, current yearCPT manual, current year ~Modifiers ~Modifiers ~Clinical examples~Clinical examples

ICD manualICD manual

Coding Companion for OphthalmologyCoding Companion for Ophthalmology

99

MODIFIERSMODIFIERS

24 Unrelated Evaluation & Management Service by the Same Physician During a Postoperative Period

25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service

(Medicare: "beyond the usual preoperative and postoperative care")

1010

MODIFIERSMODIFIERS

26 Professional Component

TC Technical Component

1111

MODIFIERSMODIFIERS

50 Bilateral Procedure

51 Multiple Procedures

52 Reduced Services

1212

MODIFIERSMODIFIERS

55 Postoperative Management Only

59 Distinct Procedural Service

79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period

1313

MODIFIERSMODIFIERS

GA Waiver of Liability (ABN-Advanced Beneficiary Notice) on file Example, when doing VF & patient's diagnosis is not in LCD for VF, or over frequency limit.

GY Service is non-covered, billing for services requested by beneficiary for denial

Example, refraction 92015

1414

MODIFIERSMODIFIERS

24 & 79 are postoperative

25 & 59 separate services

1515

PLAN FOR SUCCESSPLAN FOR SUCCESS

If you donIf you don’’t know where you are going, t know where you are going, youyou’’ll wind up somewhere else. ll wind up somewhere else.

Yogi Berra O.D. Yogi Berra O.D.

1616

RBRVSRBRVS

file://localhost/Users/alanhomestead/Documents/My Documents B 3-8-13/Adventures 11-3-12/O - S/Presentations/Repository of My PowerPoints/1 Topic Modules/RBRVS/RBRVS Aug 13.ppt

1717