Presentation on theme: "1 Part 2 Filing 3 rd Party Claims Addressing: Services and Procedure Coding Services and Procedure Coding 92000 Ophthalmology Codes92000 Ophthalmology."— Presentation transcript:
1 Part 2 Filing 3 rd Party Claims Addressing: Services and Procedure Coding Services and Procedure Coding Ophthalmology Codes92000 Ophthalmology Codes
2 Disclaimers This information was prepared by the 3rd Party Consultant to the Nebraska Optometric Association, Ed Schneider OD. To the best of his knowledge, it was current and accurate at the time it was prepared. It is not guaranteed to be error or omission free. It was prepared as general information to assist doctors and staff, and is not intended to grant rights or impose obligations.
3 Disclaimer The ultimate responsibility for the correct submission of claims and compliance with provider contracts lies with the provider of services. The Nebraska Optometric Association, and its presenters, agents, consultants and staff make no representation, warranty, or guarantee that this presentation and/or its contents are error-free or omission-free, and will bear no responsibility or liability for the results or consequences of the information contained herein.
4 BOTTOM CMS-1500 Service & Materials Supplied
5 Coding the Services You Provided Must correctly code the level of care provided Must correctly code the level of care provided Practitioner is ultimately responsible for correct coding Practitioner is ultimately responsible for correct coding Under-coding is as incorrect as over-coding Under-coding is as incorrect as over-coding
6 Reference Current Procedural Terminology, or CPT Updated annually, so needs to be replaced annually. Covers Examination coding, Ancillary testing coding Some dispensing and CL coding.
7 Examination Coding Medical Exam Coding: Medical Exam Coding: Uses CPT coding…either the Uses CPT coding…either the – Ophthalmology Codes, or – Evaluation & Management Codes Routine Exam Coding: Routine Exam Coding: Definitions unique to each routine 3rd Party Definitions unique to each routine 3rd Party Follow definitions & directions in Provider Manuals Follow definitions & directions in Provider Manuals
8 Medical Examination Coding Ophthalmology Codes defined in CPT
9 Medical Examination Coding Ophthalmology Codes Intermediate NEW: It’s been 3 years since any OD in your office has seen the patient.
10 Medical Examination Coding Ophthalmology Codes Comprehensive
11 Medical Examination Coding Ophthalmology Codes defined in CPT Chief Complaint History (3 parts) Examination Initiation or Continuation of Diagnostic and Treatment Services Medical Necessity (2 parts) Final Outcome Table
12 Chief Complaint A brief explanation of why the patient is in the office. A brief explanation of why the patient is in the office. The Chief Complaint drives the encounter The Chief Complaint drives the encounter To bill a medical insurer, the chief complaint must demonstrate Medical Necessity To bill a medical insurer, the chief complaint must demonstrate Medical Necessity
13 Chief Complaint Examples of Medical Necessity: Examples of Medical Necessity: –Eye pain –Red eye –Loss of Vision –Flashes and Floaters –Evaluation and management of Cataracts Macular Degeneration Glaucoma
14 Chief Complaint Examples of NOT Medically Necessary Examples of NOT Medically Necessary –Routine exam –Checkup –No complaint –Need new glasses –“Blurred vision” w/ reading, driving, etc.
18 blepharitis11 cartaract12 glaucoma41 7
20 Final Code must be Reasonable and Necessary Considering Considering History History Presenting Problem Presenting Problem Clinical findings Clinical findings
21 Thank You for Listening We hope this information has been helpful. Thank you for listening! See our NOA Website for more 3 rd Party Educational Videos. 3 rd Party Services Nebraska Optometric Association