J an 24 2013 EyeCodingForum.com 2012 Coding and Billing Highlights - - PowerPoint PPT Presentation
J an 24 2013 EyeCodingForum.com 2012 Coding and Billing Highlights 8 Webinars EyeCodingForum.com Jeffrey Restuccio, CPC, CPC-H M emphis TN (901) 517-1705 jeff@eyecodingforum.com 1 www.EyeCodingForum.com 2012 Webinar Highlights All
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for $199. Y
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Webinar.
Central time (1:00 pm Eastern time)
It can be paused rewound or fast forwarded just like a video.
webinars for $99 and $199, respectively, a 50% discount. You can apply credits to any recorded or future Webinar.
available on www.EyeCodingForum.com.
reimbursement, lower denials, and ensure compliance.
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1. Overview of common Vision plan scenarios 2. Review of the latest feedback on new 2012 CPT codes. 3. Update of the "Carrier-Specific Guideline" Form. A copy of this form will be made available to all attendees. 4. A quick tour of looking up ICD-9 codes by CPT code (medical necessity) and CPT codes by ICD-9 code (reverse lookup). This is a feature of the EyeCodingForum Coding Advisor – a free 30-day trial is available. 5. How to prepare for ICD-10 while still using ICD-9 for the next two years.
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Floaters 379.24 Disorders of vitreous body: other vitreous
report, unilateral or bilateral
report, unilateral or bilateral; optic nerve.
report, unilateral or bilateral; retina.
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quantitative A-scan performed during the same patient encounter
without superimposed non-quantitative A-scan)
ultrasound, immersion (water bath) B-scan or high resolution biomicroscopy
for retinal detachment, melanoma), with interpretation and report; initial.
for retinal detachment, melanoma), with interpretation and report; subsequent
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diagnostic test such as Fundus Photography (92250) or VFE (9208x). Novitas (former Highmark) does not pay on 92250
Two new 2012 ICD-9 codes are included for this Carrier:
DAM AGE
RESIDUAL S TAGE OF OPEN ANGLE GLAUCOM A
TREATM ENT WITH HIGH RISK M EDICATION NOT ELSEWHERE CLASSIFIED.
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1. Explanation of the Carrier-Specific Rule/ Guideline, why you may have never heard of this before and how to create a Carrier-Specific M anual. 2. Updated Carrier Questionnaire form 3. E Codes List. 4. Vitamin Therapy for ARM D and DES. 5. M ore on ICD-10 codes (feature every month)
and the doctor inserted one plug in the left eye and 2 plugs in the right eye on 4/ 4/ 2012.
68762.51 RLL. Humana paid for the LE and not for the RE due to global period for the Cataract surgery. What are the issues here?
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carriers do not require it for this procedure, its use here is not inaccurate. 68761 LE (this could be lower eyelid or left eyelid it is not clear) 68761-51-E3 (RUL) 68762-51-E4 (RLL)
& M codes such as punctal plugs insertion.
have nothing to do with the cataract surgery. I would appeal that this was a separate condition; it was in existence before the cataracts, unless there is clinical evidence that cataract removal causes DES.
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done here.
Carrier (to my knowledge) for the past ten years but a select few private carriers do continue to pay. This is considered a "rare" Carrier-Specific Rule.
, ABSORBABLE LACRIM AL DUCT IM PLANT , EACH
, LONG TERM , NON-DISSOL VABLE LACRIM AL DUCT IM PLANT , EACH
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1. Twelve steps to winning Carrier Denial Appeals. The review will cover: 2. Sample Appeal letters. 3. M ost common Optometry Denials 4. M ost common reasons claims are denied. 5. M edical necessity, modifiers, LCD’s, HCPC codes and all the fundamental concepts 6. Appeal Tips and Tricks you won’t learn anywhere else. 7. ICD-10 Corner – a short review of how ICD-10 codes will change from the current ICD-9.
1. Patient eligibility 2. Referring or Ordering Physician Incorrect 3. Incorrect Procedure Code 4. Incomplete/ Invalid Rendering Provider Primary Identifier 5. CLIA Item 6. M edicare Secondary Payor (M SP) 7. Claim not covered by this Payer/ Contractor 8. Patient Signature 9. Days/ Units
1. Duplicate Claims 2. M edical Necessity 3. M edicare Advantage Plans 4. Provider Eligibility 5. NCCI Edits 6. Screening/ Routine 7. Non-Covered Service 8. Patient Supplies 9. Non-Covered Charge
, ICD-9 and HCPCS rules and guidelines.
edits, the Bilateral Surgery M odifier and Global Days number as necessary.
will get paid.
1. Identify a Rejection VS Denial 2. Get organized before you call 3. Identify the carrier / gather the manual or LCD. 4. Is this a non-covered service? 5. Is pre-authorization always required? 6. ICD-9 Linking 7. NCCI Edit? 8. Correct M odifier? 9. Is this a Carrier-Specific Rule?
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1 – 5 exam items from checklist 6 exam items from checklist All 12 Eye and at least 1 (of 2) Neurological/Psychological 9 exam items from checklist
Problem Focused (99212/99201) Expanded Problem Focused (99213/99202) Detailed (99214/99203) Comprehensive (99215/99204 / 99205)
Perform and Document Level of Exam
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PF 1-5 EPF 6 Det 9 Comp 12+ 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1
1 1 1 1
1 1 1 1
1 1
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E & M codes CPT codes missing Labels / Confusing acronyms Never assume everyone understands vague or
ICD-9 codes – vague and incorrect Missing ICD-9 5th digits and 2nd code
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E & M codes CPT codes Modifiers NCCI Edits Documentation Linking / Medical Necessity Tips and Tricks
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A minimal Provider E & M visit should be a 99212, not a
99211 does not require the presence of a Provider.
Do not report this code whenever a tech performs a test
If a patient has an IOP check without seeing the provider then
If a tech or nurse is providing nutrition-therapy services for
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MOD-GA - Indicates a non-covered services and
Advises patient that the service will not be covered by Medicare and that the patient will be responsible for all charges.
Mandatory use date of Revised Form: January 1, 2012.
Notice is per occurrence. Clinic cannot use a blanket ABN on file.
An ABN and MOD-GA not required if the service (i.e., 92015 refraction services) is never covered and excluded.
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MOD-GY – Clinical Dx not covered by Medicare How is MOD-GY used in Eyecare? Add to Refraction Services 92015 when Medicare is
MOD-GY means the Medicare carrier will deny the
The secondary should pay. Note: Some Medicare carriers will cross over 92015
Note: Sometimes the crossover does not
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E & M codes CPT codes Modifiers 23, 25, 59, 26 and TC, GA, GY Documentation Linking / Medical Necessity Tips and Tricks
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Use for unlisted codes, co-management and unique situations 365.11 POAG 11 1, 4 10/15/2012 99213
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Units 1 1 1 NPI Number 375.15 DES 366.11 Senile Cataract
10/15/2012 10/15/2012 11 11 1, 4 3 99283 92015 365.72 Moderate stage
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Use for unlisted codes, co-management and unique situations V72.0 routine Vision Exam 11 1 10/15/2012
92004
Units 1 1 NPI Number 367.0 hyperopia
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Use for unlisted codes, co-management and unique situations 11 1, 2 10/15/2012
92004
Units 1 1 NPI Number 367.0 hyperopia
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92015 GY
3 365.11 POAG 365.72 Moderate stage
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Coding and documentation can be used to
Documentation is good. Always be chatting up patient’s about your
Know your top 5 insurance companies. Print a list of your top 25 ICD-9 and CPT codes.
This has multiple benefits. Many ophthalmologists and optometrists do not offer this
Earn extra income. PQRS elements. Helps meet “initiation” requirement for 920x4. Also can be used as a “counseling” visit and a 99214. Educate the patient. Ask for referrals. More detail at the end of this presentation.
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for $199. Y
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coding and billing Webinar.
time (1:00 pm Eastern time)
be paused rewound or fast forwarded just like a video.
jeff@eyecodingforum.com.
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