1. Excellence in Optometric Education John A. McGreal Jr., O.D. Missouri Eye Associates McGreal Educational Institute Understanding Medicare Guidelines - 2008

2. JAM John A. McGreal Jr., O.D. n Missouri Eye Associates n 11710 Old Ballas Rd. n St. Louis, MO. 63141 n 314.569.2020 n 314.569.1596 FAX n jamod1@aol.com

3. JAM 2008 Medicare E/M Guidelines n Compliance – How To Document the Medical Record – How To Select an E/M Codes, eye codes, “S” codes – How To Evaluate your Fees – How To Effectively Co-manage Surgical Cases – How To Increase Revenues – How To Survive an Audit – How To Understand HIPPA Privacy Rules – How To Implement a Compliance Plan

4. JAM Health Insurance Portability and Accountability Act of 1996 n President Clinton & USAG J. Reno – #2 priority: prosecution of health care fraud – $104 Million: Appropriations to HHS – $70 Million: OIG – $47 Million: FBI fraud investigation unit – Criminal offenses expanded – $10,000 fine / line item violation – suspension of payment and participation from program – Yielded $23 return on every $1 spent in 1997

5. JAM Qui Tam Relaters n Amendment to False Claims Act of 1986 n Encourages private individuals to sue in the government’s behalf n Whistleblowers - 30% of recoveries – $1 Billion paid since 1987 in Qui Tam actions n Compliance Plan – Eliminates aggressive or conservative billing philosophies – Removes incentives for whistleblowers – Improves collections while reducing audit risks

6. JAM Medicare Review Strategies - 2008 n Error rates at below 7% nationally n E/M codes represent 75% of errors (highest for Part B) – 10-1 overpayment –underpayment – Insufficient documentation and incorrect coding n OB/GYN specialty highest error rate nationally at 35.75% n Diagnostic radiology specialty highest projected dollars paid incorrectly at 48 million

7. JAM Top 5 Errors by Profession - 2006 n OB/GYN n Neurology n Chiropractic n Optometry – 11.6% n Nephrology

8. JAM Medicare Review Strategies - 2008 n E/M established codes n Laboratory n Hospital E/M, subsequent n Consultation codes n E/M new codes n Electrocardiograms n Chiropractic n Rituximab n Hospital E/M, initial

9. JAM HIPAA in Bite Sized Chunks n Standards for transactions conducted electronically n Standards to protect privacy of personal health information n Standards to protect security of personal health information when stored electronically n Uniform federal identifiers of providers, health plan, employers and individuals

10. JAM NPI Identifier n Enumerator / National Provider System / ANSI – Must be used by May 23, 2007 – Providers need to apply online at CMS website n Identifiers for providers, health plans, employers and individuals n National Provider Identifier (NPI) – 10 digit string of alphanumeric characters, includes check digit – Format allows 200 billion identifiers without re-using values n Benefits of NPI identifiers – All transactions for ALL health plans – NPI will never change – Facilitates coordination of benefits – Facilitates tracking claims and payments – Facilitates identifying and prosecuting fraud n Start sharing NPIs NOW with consultants & Specialists!!

11. JAM Code Set Adoption in HIPAA n CPT-4: Current Procedure Terminology n CDT: Code on Dental Procedures and Nomenclature (Proposal to implement ICD-10) n ICD-9-CM (Volume 1,2): International Classification of Diseases (Proposal to implement ICD-10) n ICD-9-CM (Volume 3): inpatient disease codes n NDC: National Drug Code n HCPCS: Healthcare Common Procedure Coding System

12. JAMINTRODUCTION n CMS = Center for Medicare & Medicaid Services (formerly HCFA) - announced June 14, 2001 – Center for Medicare Management - traditional fee- for-service programs – Center for Beneficiary Choices - provide beneficiaries with information on Medicare, MedicareSelect, Medicare+Choice, and Medigap options – Center for Medicaid and State Operations - focus on Medicaid and state administered services

13. JAMINTRODUCTION n CMS n CPT n ICD – www.icd9coding1.com/flashcode/userRegister.do n Medicare n Major Medical n E/M Coding (99XXX) n Eye Coding (92XXX) n Special Ophthalmic Codes

14. JAM E/M GUIDELINES n New/Established Patient n Chief Complaint n History of Present Illness n Family History n Past History n Social History n Review of Systems

15. JAM E/M DESCRIPTORS n History * n Examination* n Medical Decision Making* n Counseling n Coordination of Care n Nature of the Presenting Problem n Time

16. JAM CATEGORIES OF SERVICE CATEGORIES OF SERVICE n Office Visits (E/M Codes) – New99201-99205 – Estab99211-99215 n Office Visits (Eye Codes) – New92002-92004 – Estab92012-92014 n Consultations (E/M Codes) – Office99241-99245

17. JAM E/M Coding - Consultation E/M Coding - Consultation n Office Consultations – Opinion / Advice – Not Referral n Duration - short n Continuity - expect patient back n Documentation - required

18. JAM E/M Coding - Referral E/M Coding - Referral n Referral – Treatment or Care n Duration - long n Continuity - Do not expect patient back n Documentation - not required, but courtesy n Warning! - carefully consider the language used in the correspondence to your consulting specialists – avoid the term referral, unless that is what you mean!

19. JAM SELECTING AN E/M LEVEL SELECTING AN E/M LEVEL n Identify Category of Service n Identify Extent of History Taking n Identify Extent of Examination n Identify Complexity of Medical Decision Making n Review E/M Descriptors

20. JAM E/M CODING - OFFICE VISITS n New Patient (3 of 3) – 99201 - PFH / PFE / SDM / 10 – 99202 - EFH / DFE / SDM / 20 – 99203 - DH / DE / LDM / 30 – 99204 - CH / CE / MDM / 45 – 99205 - CD /CE / HDM / 60

21. JAM E/M Coding - Office Visits E/M Coding - Office Visits n Established Patient (2 of 3) – 99211 - Minimal / 5 – 99212 - PFH / PFE / SDM / 10 – 99213 - EFH / EFE / LDM / 15 – 99214 - DH / DE / MDM / 25 – 99215 - CH / CE / HDM / 40

22. JAM DOCUMENTATION OF HISTORY DOCUMENTATION OF HISTORY n Problem Focused History (PFH) – CC / 1-3 HPI n Expanded Problem Focused History (EPF) – CC / 1-3 HPI / Ocular ROS n Detailed History (DH) – CC / 4 HPI / Ocular ROS / ROS-2 / 1 OF 3 PFSH n Comprehensive History (CH) – CC / 4 HPI / Ocular ROS / ROS-10 / 3 OF 3 PFSH (NEW) OR 2 OF 3 PFSH (ESTAB)

23. JAM Eye Examination Documentation n VA / CVF / Pupils & Iris / Adnexa n Bulbar & Palp Conjunctiva n EOM n SLE: Cornea / Lens /AC n IOP / Optic Nerve / Posterior Segment n Neurologic: Orientation (Time / Place / Person) n Psychiatric: Mood & Affect (Depression /Anxiety /Agitation)

24. JAM DOCUMENTATION OF EXAMINATION DOCUMENTATION OF EXAMINATION n Problem Focused Exam (PFE) – Limited Exam / l - 5 Elements n Expanded Problem Focused Exam (EPF) – Limited Exam / 6 Elements n Detailed Exam (DE) – Extended Exam / 9 Elements n Comprehensive Exam (CE) – Complete Single System Exam – All Elements

25. JAM Medical Decision Making Medical Decision Making n Straightforward (SF) – # Dx / Rx Options - Min / Data - Min / Risk - Min n Low Complexity (LC) – # Dx / Rx Options - Lim / Data - Lim / Risk - Low n Moderate Complexity (MC) – # Dx / Rx Options - Mult / Data - Mod / Risk -Mod n High Complexity (HC) – # Dx / Rx Options - Ext / Data - Ext / Risk - High

26. Comprehensive Ophthalmological Service 92004 / 92014 n Complete system evaluation, 8 or more elements n Need not be performed at one session n Integrated services where med decision making cannot be separated from examination methods n Includes history, medical observation, external & ophthalmoscopic, gross visual fields, sensorimotor, biomicroscopy, consultations, dilation (cycloplegia), mydriasis, tonometry, initiation of diagnosis and treatment programs, prescription of medication

27. JAM Comprehensive Ophthalmological Service 92004/92014 n Always includes initiation of diagnosis and treatment programs – includes the prescription of medication, and arranging for special ophthalmological diagnostic / treatment services, consultations, laboratory procedures and radiological services

28. JAM Intermediate Ophthalmological Service 92002 / 92012 Intermediate Ophthalmological Service 92002 / 92012 n Evaluation of new / existing condition, complicated with a new diagnostic or management problem n Integrated services where med decision making cannot be separated from examination methods n Includes history, medical observation, external & adnexal, & other diagnostic procedures, biomicroscopy, mydriasis ophthalmoscopy and tonometry

29. JAM Intermediate Ophthalmological Service 92002 / 92012 n Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient n 7 or less elements

30. JAM 2004 New HCPCS Codes n “S” codes are useful for some private insurers n Medicare and other federal payers do not recognize them n They are useful when CPT does not have a code to accurately describe the service (i.e. LASIK, PTK, PRK, corneal topography) or for invoicing self-pay patients. n They specifically describe “routine exams” including refractions and permit a different charge

31. JAM HCPCS “S” Codes HCPCS “S” Codes n S0592 Complicated contact lens evaluation n S0620 Routine ophthalmologic exam including refraction; new patient n S0621 Routine ophthalmologic exam including refraction; established patient

32. JAM 2006 Medicare Fee Schedule Office Visits n 99201$34.23-99211 $19.96- n 99202$60.83-99212 $35.96- n 99203$90.58-99213 $49.10- n 99204$128.26-99214 $77.08- n 99205$163.20-99215 $112.36- n 92002$66.03-92012 $60.50- n 92004$120.51-92014 $89.53-

33. JAM 2006 Medicare Fee Schedule Consultations n 99241$46.96- n 99242$86.00- n 99243$114.67- n 99244$162.01- n 99245$209.65-

34. JAM Refraction 92015 Refraction 92015 n Non-covered service n Can be billed to beneficiary – failure to do so results in lost revenues n Reminders – Charge only for “Rx-able” refractions – Do not forget to charge for the final refraction when changing spectacles in a post-operative cataract patient

35. JAM Gonioscopy 92020 n Bilateral n Requires documentation – describe visible angle structures n No limitations to diagnostic groups in most states n Fee$23.12- / $25.47

36. JAM Visual Field 9208x n Bilateral n Requires Interpretation – separate report form – narrative in body of medical record, on date of service n Fee $44.77- (-81) / $46.18 n Fee $58.29- (-82) / $59.09 n Fee $66.96- (-83) / $68.17

37. Oculus Easy Field Perimeter n Screening AND Threshold fields n Color LCD-Display n Fixation monitoring – CCD camera n Stores up to 40,000 exams n Built-in printer

38. JAM Extended Ophthalmoscopy 92225 / 92226 n Unilateral n Initial (-225) vs. Subsequent (-226) n Implies detailed, extra ophthalmoscopy – document fundus lenses used n Modifiers RT /LT n Requires retinal drawings & interpretation – sizes, colors and dimensions carrier specific n Fee 92225 ($20.38-/$21.69) 92226 ($18.61- /$19.53)

39. JAM Fundus Photography 92250 n Bilateral n Not Bundled n Requires Interpretation n Fee$65.86-/$69.46

40. Fundus Retinal Photos ROI n Synemed (Canon 8+MP) n Cost $22,500.00 n Lease $500.00 n Breakeven 2 photos / wk n 8-10 MP digital non- mydriatic n 10 images / wk – lease = $22,273.20 annual revenue

41. JAM 2006 New ICD-9 Codes n Must report with 250.5 n 362.03 Nonproliferative diabetic retinopathy NOS n 362.04 Mild nonproliferative diabetic retinopathy n 362.05 Moderate nonproliferative diabetic retinopathy n 362.06 Severe nonproliferative diabetic retinopathy n 362.07 Diabetic macular edema – Must report with ICD code for diabetic retinopathy n 362.01 = background diabetic retinopathy n 362.02 = proliferative diabetic retinopathy n 362.03 – 362.07

42. JAM External Ocular Photography 92285 n Report for documentation of medical progress – Ex.: close-up photography, slit lamp photography, goniophotography, stereo-photography n Bilateral n Not Bundled n Requires Interpretation and report n Fee$39.77-/$42.12

43. JAM RPS AdenoDetector 87809 n Bilateral n Infectious agent detection by immunoassay with direct observation, not otherwise specified n Modifier: QW for CLIA waived products n ICD-9 Positive test result – 077.3 other adenoviral conjunctivitis; acute follicular conj – 077.99 other diseases of conjunctiva due to viruses n ICD-9 Negative test result – 372.02 Acute follicular conjunctivitis, excludes EKC, PCF – 372.05 Acute atopic conjunctivitis n Fee$16.76

44. JAM Serial Tonometry 92100 n Bilateral n Requires Interpretation & Report – Example: Angle closure glaucoma – multiple measurements over time n Fee$76.05-/80.60

45. JAM Scanning Computerized Ophthalmic Diagnostic Imaging 92135 n Unilateral n Applies to glaucoma and retinal evaluations – Heidelberg / Heidelberg Retinal Topography (HRT III) – Carl Zeiss / Optical Coherence Tomography (OCT) – Carl Zeiss / Laser Diagnostic Technology (GDX) – Marco / Retinal Thickness Analyzer (RTA) – Optovue / RTVue n Requires Interpretation & report n Fee$38.91-/$40.64

46. JAM Scanning Laser Covered Diagnosis List n 362.85 retinal nerve fiber bundle defects 377.00-377.04 n 364.22 glaucomatocyclitic crisisPapilledema n 364.53 pigmentary iris degeneration n 364.73 goniosynechiae n 364.74 pupillary membranes n 364.77 recession of the angle n 365.00-365.9 glaucoma n 368.40-368.45 visual field defects n 377.9 unspecified disorder of optic nerve or pathways

47. JAM Scanning Laser 92135 n Moderate Damage - payable once or twice per year, not with a field – Visual field examples n moderate reduction in retinal sensitivity n temporal wedge – Optic Nerve examples n enlarged cup with sloped or pale rim n focal notch n rim/disc >0.1 but <0.2 n prominent lamina cribrosa

48. JAM Scanning Laser 92135 n Advanced Damage - rarely payable, fields more valuable – Visual field examples n loss of central vision n temporal island remains n severe reduction in retinal sensitivity n absolute defects to within 3 degrees of fixation – Optic Nerve examples n rim destroyed n rim/disc ratio<0.1

49. JAM Pachymetry 76514 n Bilateral n Measurement of central corneal thickness (CCT) proven by Ocular Hypertension Treatment Study (OHTS) to be standard of care in diagnosis and management of glaucoma, glaucoma suspect and ocular hypertension n Also billable for keratoconus, corneal transplants, cataracts with corneal dystrophies, guttata, edema n Requires Interpretation & Report n Fee$11.18-/$11.42

50. Reichert IOPac n Portable n Battery operated n Stores up to 1000 pts. n USB and infrared interface n Down load to PC and printer n Detachable probe – Easily replaced if necessary – 888 849 8955

51. JAM Computerized Corneal Topography 92025 n Bilateral or unilateral n Requires interpretation & report n No limitations to diagnostic groups in most states n Fee$23.12- / $28.47

52. JAM 92025 Corneal Topography n ICD-9 Codes that Support Medical Necessity – 367.22* Irregular astigmatism – 371.00 Corneal Opacity Unspecified – 371.23 Bullous Keratopathy – 371.50 Hereditary Corneal Dystrophy Unspecified – 371.52 Other Anterior Corneal Dystrophy – 371.57 Endothelial Corneal Dystrophy – 371.60 Keratoconus Unspecified – 371.61 Keratoconus Stable Condition

53. JAM 92025 Corneal Topography n ICD-9 Codes that Support Medical Necessity – 371.62 Keratoconus Acute Hydrops – 372.40 Pterygium Unspecified – 996.51 Mechanical Complication Prosthetic Corneal Graft – V42.5 Cornea Replaced by Transplant – V45.61* Cataract Extraction Status – V45.69* Other States Following Surgery of Eye /Adnexa – *367.22 must be accompanied by V45.61 or V45.69 – *V45.61 must be accompanied by 367.22 – *V45.69 must be accompanied by 367.22

54. JAM Therapeutic Contact Lens 92070 n Unilateral n Bundled with 92xxx, includes supply of lens n Recommendations – use disposable lenses – accept a less than optimum cosmetic fit – tolerate debris on and beneath lens – remove only once and do not replace – liberally hydrate prior to removal n Fee$58.93-/62.97

55. JAM Correction Trichiasis 67820* n Epilation n By forceps n ICD-9 – 374.05 Trichiasis without entropion – 374.01 Senile entropion n Fee$43.79-/$54.29

56. JAM Removal of Foreign Body 65205* n External Eye, Conjunctiva – superficial – scleral, non-perforating n ICD-9 – 930.18 FB in cul-de-sac n Fee$45.52-$48.82

57. JAM Removal of Foreign Body 65210* n External Eye, Conjunctiva – embedded (includes concretions) – subconjunctival – scleral, non-perforating n ICD-9 – 930.18 FB in other sites or combined sites n Fee$55.64-$59.74

58. JAM Removal of Foreign Body 65222* n External Eye, Corneal – with Slit Lamp n ICD-9 – 930.0 FB in cornea n Fee$61.25-/$65.75

59. JAM Sensorimotor Examination 92060 n Quantitative measurement of ocular deviation – document all major fields of gaze n Bilateral n Requires interpretation and report n Fee$48.93- n 92065 – Orthoptic and / or pleoptic training, with continuing medical direction and evaluation n Fee$33.78+/$32.38

60. JAM Dilation of Lacrimal Puncta 68801* n With or Without Irrigation n ICD-9 – 375.22 Epiphora, insufficiency of drainage – 375.42 Chronic Dacryocystitis – 375.52 Stenosis, Lacrimal Punctum – 375.56 Nasolacrimal Duct Obstruction n Fee $98.07-/$103.08

61. JAM Punctal Occlusion By Plug 68761 n Temporary (collagen) or Permanent (Silicone) n Payment is per puncta (modifiers required) – E1=left upperE3=right upper – E2=left lowerE4=right lower n Global period - 10 days n Supply code-included in procedure code, not separately billable n Fee$120.91-/$130.02

62. JAM n ICD-9 – 370.21 Punctate Keratitis – 370.23 Filamentary Keratitis – 370.34 Exposure Keratitis – 370.80 Other forms of Keratitis – 370.90 Unspecified Keratitis – 371.42 Recurrent Corneal Erosion – 374.41 Eyelid Retraction – 375.15 Unspecified Tear Film Insufficiency – 710.20 Sicca Syndrome; use additional systemic manif. code Punctal Occlusion By Plug 68761

63. JAMModifiers – 32 Mandated Services – 50 Bilateral Procedure – 24 Unrelated Service / Same Doctor – 25 Separate Service / Same Doctor / Same Day – 52 Reduced Service / Informational / Not Reduced Fee – 54 Surgical Care Only – 55 Post-Op Care Only – 51 Multiple Procedures – RT / LT Right / Left – E 1- E4 Identifies Puncta

64. JAM Comanagement of Surgery n Procedures / 66984 / $594.76-/$639.69 n Global Periods - usually 90 days n Value - up to 20% n Modifiers (-54,-55) n Range Dates n Rules - Medicare Transfer Agreement in MD record n Correspondence n Legal/Political/Inter-professional Issues

65. JAM Complicated Cataract Surgery 66982 n New CPT code for 2001 / $832.60-/$850.80 n Extracapsular cataract extraction with insertion of IOL, complex, requiring devices or techniques not generally used in routine cataract surgery – 2% of all cataract surgeries involve extraordinary work n iris expansion devices, suture support for IOL, posterior capsulorrhexis, small pupil, subluxed lens, Pseudoexfoliation, trauma, Marfan’s, glaucoma, uveitis n pediatric population n Advanced, white, hard cataract

66. JAM CASE 1: Cataract n CPT / ICD – 92015 / Myopia (367.1) = $20.00 – 99203 / Cataract (366.16) = $95.00 – Total $115.00 n Rx: Spectacles n RTO: 1YR n CPT / ICD – 92015 / Myopia (367.1) = $20.00 – 99214 / Cataract (366.16) = $80.00 – Total $100.00

67. JAM CASE 2: Blepharoconjunctivitis n CPT / ICD – 99213 or 92012 / Blepharitis (373.00) = $50.00 or $63.00 n Rx: Bacitracin Oint hs / Tobradex qid / Lid Hygiene / AFTs n RTO: 1 WK n CPT / ICD – 99212 / Blepharitis (373.00) = $$45.00 – Total $95.00 or $108.00

68. JAM CASE 3: Allergic Conjunctivitis n CPT / ICD – 99213 or 92012 / Conjunctivitis allergic (372.14) – $50.00 or $63.00 n Rx: Pataday QD / Cold Packs / AFTs n RTO: 1 WK n CPT / ICD – 99212 or 92012 / Conjunctivitis, allergic (372.14) = $$45.00 or $63.00 – Total $95.00 or $126.00

69. JAM CASE 4: Rosacea (Skin & Eye) n CPT / ICD – 99213 or 92012 Meibomianitis (373.12) / Acne Rosacea (695.30) = $50.00 or $63.00 – 92285 / (370.01) Marginal keratitis = $45.00 – Total $ 95.00 or $108.00 n Rx: Zylet QID / Lid Hygiene / Minocycline 50mg BID / MetroCream 0.75% BID RTO: 2 D n CPT / ICD – 99212 or 99213 / Meimbomianitis (373.12) = $50.00 or$63.00 – Total $145.00 or 171.00

70. JAM CASE 5: Corneal Foreign Body n CPT / ICD – 99213-25 / Abrasion (918.1) = $50.00 – 99285 / Abrasion (918.1) = $45.00 – 65222 / Corneal Foreign Body (930.00) = $65.00 – Total $ 160.00 n Rx: Acular LS QID / Zymar QID / Patch +/- Ibuprofen 400mg n RTO: 1 Day

71. JAM CASE 6: Misdirected Lashes n CPT / ICD – 99213-25 / SPK (370.21) = $50.00 – 92285 / SPK (370.21) = $45.00 – 67820/ Trichiasis (374.05) = $45.00 – Total $140.00 n Rx: Xibrom BID / AFTs n RTO: 1 Day / PRN

72. JAM CASE 7: Corneal Erosion n CPT / ICD – 99213 / Recurrent Corneal Erosion (371.42) = $50.00 – 92070 / Recurrent Corneal Erosion (371.42) = $70.00 – Total $120.00 n Rx: Vigamox TID / Nevanac TID / Bandage SCL n RTO: 1 Day n CPT / ICD – 99212 or 92012 / Recurrent Corneal Erosion (371.42) = $45.00 or $63.00 – Total $165.00 or $183.00

73. JAM CASE 8: Bacterial Keratitis n CPT / ICD – 99213 or 92012 / Bacterial Keratitis (370.03) = $50.00 or $63.00 – 92285 / Bacterial Keratitis (370.03) = $45.00 – Total $95.00 or $108.00 n Rx: Zymar q2h n RTO: 1 Day n E/M: 99212 or 99213 or…..? – Total $145.00 and up

74. JAM CASE 9: Central Serous Retinopathy n CPT / ICD – 99213 / Central serous retinopathy (362.41) = $50.00 – 92225-LT / Central serous retinopathy (362.41) = $20.00 – 92250 / Central serous retinopathy (362.41) = $70.00 – Total $140.00 n Rx: Observation RTO: 1 Mos n CPT / ICD – 99213 / Central serous retinopathy (362.41) = $50.00 – 92226-LT / Central serous retinopathy (362.41) = $20.00 – 92135-LT / Central serous retinopathy (362.41) = $45.00 – Total $255.00

75. JAM CASE 10: Macular Degeneration n CPT / ICD – 99203 / Age Related Macular Degeneration (362.51) = $95. – 92225-RT, 92225-LT / (362.51) = $40.00 – 92250 / (362.51) = $70.00 – Total $205.00 n Rx: Amsler Grid / Vitamins n RTO: 6 Mos n CPT / ICD – 99212 / 92135-RT, 92135-LT / (362.51) = $135.00 – Total $340.00

76. JAM CASE 11: High Risk Medication n CPT / ICD – 99213 / Rheumatoid Arthritis (714.0), High Risk Medical Treatment (V58.69) = $50.00 – 92226-RT, 92226-LT / (714.0, V58.69) = $40.00 – 92083 / (714.0, V58.69) = $70.00 – Total $160.00 n Rx: Observation n RTO: 6 Mos n CPT / ICD – Same as above = $160.00 – Total $320.00

77. JAM CASE 12: Dermatitis n CPT / ICD – 99213 or 92012 / Dermatitis (373.32) = $50.00 or $63.00 – 92285 / (373.32) = $45.00 – Total $95.00 or $108 n Hydrocortisone 1.0% QID / Cold Packs n RTO: 1 WK n CPT / ICD – 99212 / (373.32) = $45.00 – Total $140.00 – $153.00

78. JAM CASE 13: Glaucoma Suspect n CPT / ICD – 99214 / Glaucoma Suspect (365.01) = $80.00 – 92020 / (365.01) = $25.00 – 76514 / (365.01) = $15.00 – 92250 / (365.01) = $70.00 – 92083 / (365.01) = $70.00 n CPT / ICD – 99213 or 92012 / (365.01) = $50.00 or $63.00 – 92235-RT, 92235-LT / (365.01) = $90.00 – Total $400.00 or $413.00 n Rx: Initiate or continue treatment or consultation- MD

79. JAM CASE 14: Dry Eye n Dx: Documentation: Narrative & Shirmer Strips n CPT / ICD Temporary Collagen Plugs – 99214-25 / Dry Eye Syndrome (370.33) = $80.00 – 68761-E2 / (370.33) = $125.00 – 68761-E4 / (370.33) = $125.00 (Paid at 50% allowable) – Total $267.00 n E/M: Permanent Silicone Plugs – 99212-25, 68761-E2, 68761-E4 / (370.33) = $227.00 n RTO: >10 Days global period n Total $494.00

80. JAM CASE 15: Cataract Co-Management n CPT / ICD – 66984-55, RT / 366.16 – Date of Service-is date of surgery – Range Dates-starts on date of transfer of care from MD to OD, ends 90 days from date of surgery n Rx: Post-Operative Care n RTO: Outcome dependant n E/M: 92015 and Material/Hardware Codes (DME)

81. Monitor Compliance with Audits n Develop a “Documentation” team n Monthly Assessment – 10 charts/Provider n Report your Results – All staff, residents, students n Acknowledge positive & negative variances – RETRAIN, RETRAIN..

82. JAM THANK YOU! n Primary Eyecare Network – 1.800.444.9230 www.primaryeye.net – Medicare Compliance Kit n Health History Questionnaire n Examination Forms n E/M Worksheets n ICD-9 Codes n Interpretation/Report form – Medicare A-Z Manual – Superbills / Signature on File stickers / Electronic Claims – HIPAA Compliance Manual

83. Thank you Excellence in Optometric Education Missouri Eye Associates McGreal Educational Institute Missouri Eye Associates McGreal Educational Institute