CCI 18.0 Update: 67961-67966 Includes Graft Site Preparation   (February 2012)

Also: Watch for these new eyelid reconstruction Correct Coding Initiative edits. If your ophthalmic surgeon performs eyelid repairs and reconstructions, heads up. The Correct Coding Initiative wants to make sure you’re paying attention to CPT® definitions – and if you’re not, you could find yourself with claims denials on your hands. CCI released version 18.0, effective Jan. 1, revealing 15,530 new active pairs and 6,197 code pair terminations, according to Frank D. Cohen, MPA, MBB, senior [...]

Part B Update: Despite CPT® Revision, Medicare Won’t Update ‘New Patient’ E/M Rules for 2012   (February 2012)

Plus: Claims reprocessing has completed, so make sure your claims have been corrected.As many veteran ophthalmology coders are aware, just because CPT® makes a change, you aren’t guaranteed to see Medicare follow suit. That’s the case with the latest new vs. established patient definition that CPT® 2012 published, which won’t have much impact on Part B claims, CMS reps said during a Jan. 24 Open Door Forum.Background: CPT® 2012 states, A new patient is one who [...]

Fee Schedule Update: Expect 2-Month Medicare Payment Reprieve   (February 2012)

SGR formula fix is key.You won’t face a 27 percent Medicare pay cut beginning Jan. 1 after all – at least not for two months. That’s because the rate reduction was once again kicked to the curb by Congress, resulting in a Medicare Physician Fee Schedule conversion factor of $34.0376 through Feb. 29.On Dec. 23, the House followed the Senate’s lead in voting to halt the Medicare pay cut for two months, which will freeze Medicare [...]

Workers’ Compensation: 5 Guidelines Ease the Pain of Billing Workers’ Compensation   (February 2012)

If you don’t get pertinent information before seeing the patient, expect trouble when you start the billing process.If just thinking about processing a workers’ compensation claim for foreign bodies lodged in the eye gives you a headache, don’t worry – you aren’t alone. Remembering a few guidelines can help ease the pain.Problem: One of the major points of confusion is that, while workers’ compensation is authorized with federal guidance, it is a state-run program. That is, [...]

You Be the Coder: Long-Standing Strabismus   (February 2012)

Question: Another ophthalmologist referred a new patient with long-standing strabismus to us. How should I code this visit?Colorado subscriberAnswer: The answer depends upon why the referring ophthalmologist sent the patient to your physician. 1) Was this a request for second opinion with recommendations for care?2) Or was this referral due to a general ophthalmologist asking a second ophthalmologist who specializes in strabismus-related surgery to take over management of the patient’s problem? A consultation code (99241-99245) [...]

Reader Question: 367.9 Is Best Choice for Ametropia   (February 2012)

Question: Which ICD-9 code should I report for ametropia?Kansas SubscriberAnswer: The appropriate diagnosis code for ametropia, a refractive error when viewing distant objects, is 367.9 (Unspecified disorder of refraction and accommodation).If you have a more specific diagnosis, you should report that instead, such as 367.1 (Myopia).Watch for: If the ophthalmologist dictates his notes, be sure the transcriptionist distinguishes between ametropia and emmetropia, the eye’s normal refractive state, in which no refractive error is present.If the [...]

Reader Question: Collect Surgical Deductibles Up Front   (February 2012)

Question: We often have patients who don’t pay their deductible after surgery. Is there a recommended way to collect these payments up front?South Dakota SubscriberAnswer:  Yes, you may collect a deductible upfront. The first step is to confirm the deductible amount with the payer. Insurance verification services now make it possible for practices to determine if a patient has met his deductible, or how much deductible remains unpaid. Others provide just information on what the [...]

FBR: 65205-65222 Coding Success Depends on Location, Penetration Level   (January 2012)

Bonus: Documented embedded corneal FBRs can earn $10 more per procedure. Are you routinely selecting your foreign-body removal (FBR) code based on what instrument the ophthalmologist used? You may be reporting the wrong code – and collecting the wrong payments. Get the truth behind this and four other FBR myths that routinely trip up your ophthalmology coding colleagues. Myth #1: The type of instrument the ophthalmologist uses determines what foreign-body removal code to report. Reality: The [...]

Physician Fee Schedule 2012: Brace Your Practice for 27% Medicare Conversion Factor Cut   (January 2012)

Could a reprieve be around the corner?‘Tis the season for another round of tense waiting to see if you’ll get a dramatic reduction in 2012 Medicare payments for your general surgical services. “The calendar year 2012 Physician Fee Schedule [PFS] conversion factor is $24.6712,” notes the 2012 Medicare Physician Fee Schedule Final Rule, printed in the Nov. 28 Federal Register – and that could mean a big cut in your pay.Look for Congressional ReliefThe conversion factor [...]

Diabetic Complications: 250.00 Alone Won’t Cut It for Diabetic Patients With Ophthalmic Manifestations   (January 2012)

Hint: Make sure to code the specific diabetic Dx your ophthalmologist is providing care for.If you’re feeling hesitant about filing claims for patients with ophthalmic complications from diabetes, arm yourself with diagnosis basics and an understanding of manifestations to sail through diabetic patient coding.1. Master Decimal Places for DxOne of the most common mistakes coders make when filling a claim on a diabetic patient is reporting 250.00 (Diabetes mellitus without mention of complication) for the [...]