Medical Coding for Optometry Alan Homestead OD Seattle WA

Who? Private practice – Seattle Private practice – Seattle Pacific U 1980 Pacific U 1980 I.H.S. – Apache Resv. AZ I.H.S. – Apache Resv. AZ CAC Noridian CAC Noridian Director Billing & Coding – Power Practice Director Billing & Coding – Power Practice MBA Faculty MBA Faculty Columns – O.M., Rev Cor & CL, Ophth Office Columns – O.M., Rev Cor & CL, Ophth Office Creator - AccuFee Creator - AccuFee 2

DISCLOSURES The Power Practice The Power Practice AccuFee AccuFee Professional Practice Systems Professional Practice Systems Not employee of insurance or EHR company Not employee of insurance or EHR company 3

INTRODUCTION All coding topics are fair game All topics can be returned to All topics can be expanded All topics can be argued 4

INTRODUCTION Rules differ by insurance, by MAC, by region – share. I may not agree with state expert or last speaker. Rules are vague. “Don’t ask” rule makers unless you already know. 5

INTRODUCTION Assumption - you know nothing Assumption - you know nothing Repetition is the key to learning, will cover some topics more than once Repetition is the key to learning, will cover some topics more than once Participate! The more you participate the better you remember Participate! The more you participate the better you remember 6

SOURCE OF INFORMATION Original 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 Policy Medical Policy 7

SOURCE OF INFORMATION Opinion Coding & Billing Articles in Magazines Coding & Billing Articles in Magazines Online Sources Online Sources Vendors Vendors AOA, AAO AOA, AAO Speakers/Authors - Be wary of what you hear, especially me. Speakers/Authors - Be wary of what you hear, especially me. Final Decision = Auditor or Judge Final Decision = Auditor or Judge 8

SOURCE OF INFORMATION Recommendation CPT manual, current year CPT manual, current year ~Modifiers ~Modifiers ~Clinical examples ~Clinical examples ICD manual ICD manual Coding Companion for Ophthalmology Coding Companion for Ophthalmology 9

MODIFIERS 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") 10

MODIFIERS 26 Professional Component TC Technical Component 11

MODIFIERS 50 Bilateral Procedure 51 Multiple Procedures 52 Reduced Services 12

MODIFIERS 55 Postoperative Management Only 59 Distinct Procedural Service 79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period 13

MODIFIERS 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

MODIFIERS 24 & 79 are postoperative 25 & 59 separate services 15

PLAN FOR SUCCESS If you don’t know where you are going, you’ll wind up somewhere else. Yogi Berra O.D. 16

RBRVS file://localhost/Users/alanhomestead /Documents/My Documents B /Adventures /O - S/Presentations/Repository of My PowerPoints/1 Topic Modules/RBRVS/RBRVS Aug 13.ppt file://localhost/Users/alanhomestead /Documents/My Documents B /Adventures /O - S/Presentations/Repository of My PowerPoints/1 Topic Modules/RBRVS/RBRVS Aug 13.ppt file://localhost/Users/alanhomestead /Documents/My Documents B /Adventures /O - S/Presentations/Repository of My PowerPoints/1 Topic Modules/RBRVS/RBRVS Aug 13.ppt file://localhost/Users/alanhomestead /Documents/My Documents B /Adventures /O - S/Presentations/Repository of My PowerPoints/1 Topic Modules/RBRVS/RBRVS Aug 13.ppt 17