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 eight below and 12 more (2013) are available as a package for $199. Y ou select only the Webinars you want. EyeCodingForum.com 2
EyeCodingForum Webinars • Individual Webinars are $49 each. • Every month we conduct an Eyecare-specific coding and billing Webinar. • They are 50 minutes and are typically on Thursday at noon Central time (1:00 pm Eastern time) EyeCodingForum.com • Every Webinar is recorded and can be reviewed at a later date. It can be paused rewound or fast forwarded just like a video. • Packages of Webinars are available in groups of 4 and 8 webinars for $99 and $199, respectively, a 50% discount. You can apply credits to any recorded or future Webinar. • Twelve additional Webinars were recorded in 2013. All are available on www.EyeCodingForum.com. • Every Webinar includes valuable information how to increase 3 reimbursement, lower denials, and ensure compliance.
May 30 2012 EyeCareCoding and Billing Webinar 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. EyeCodingForum.com 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. 4
Floaters (379.24) Medical Necessity (1) Floaters 379.24 Disorders of vitreous body: other vitreous opacities (floaters) is payable on the following per FL M CR. • 92132 SCODI, anterior segment, with interpretation and EyeCodingForum.com report, unilateral or bilateral • 92133 SCODI, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve. • 92134 SCODI, posterior segment, with interpretation and report, unilateral or bilateral; retina. • 92250 Fundus photography with interpretation and report. 5
Floaters (379.24) Medical Necessity (2) • 76510 Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter • 76512 Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) EyeCodingForum.com • 76513 Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution biomicroscopy • 92225 Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial. • 92226 Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and 6 report; subsequent
Fundus Photography 92250 Medical Necessity • Cannot confirm that Diabetes Code 250.0x supports any diagnostic test such as Fundus Photography (92250) or VFE (9208x). Novitas (former Highmark) does not pay on 92250 on 250.0x but does pay on the following: Two new 2012 ICD-9 codes are included for this Carrier: EyeCodingForum.com • 365.05 OPEN ANGLE WITH BORDERLINE FINDINGS, HIGH RISK • 365.06 PRIM ARY ANGLE CLOSURE WITHOUT GLAUCOM A DAM AGE • 365.10 - 365.15 OPEN-ANGLE GLAUCOM A UNSPECIFIED - RESIDUAL S TAGE OF OPEN ANGLE GLAUCOM A • V58.69 LONG-TERM (CURRENT) USE OF OTHER M EDICATIONS • V67.51 FOLLOW-UP EXAM INATION FOLLOWING COM PLETED TREATM ENT WITH HIGH RISK M EDICATION NOT ELSEWHERE 7 CLASSIFIED.
J une 12 2012 EyeCareCoding Webinar 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)
Punctal Plug S cenario • We performed a cataract surgery on the right eye of a patient on 1/ 31/ 2012. The patient had a complaint of very dry eyes and the doctor inserted one plug in the left eye and 2 plugs in the right eye on 4/ 4/ 2012. EyeCodingForum.com • The doctor coded 99070 (supply) 68761 LE, 68761.51 RUL, 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? 9
Punctal Plug S cenario • M odifier 51 means “ multiple procedures” and while most 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) EyeCodingForum.com 68762-51-E4 (RLL) • M odifier 24 is an E & M modifier and should not impact non-E & M codes such as punctal plugs insertion. • The E1 through E4 modifiers should be used as listed above. • The punctal plugs should be linked to the DES ICD-9 code and 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 10 removal causes DES.
Punctal Plug S cenario • I would never report the CPT supply code for the plugs as was done here. • The HCPCS codes for the plugs are not paid by any M edicare Carrier (to my knowledge) for the past ten years but a select few private carriers do continue to pay. This is considered a EyeCodingForum.com "rare" Carrier-Specific Rule. • A4262 TEM PORARY , ABSORBABLE LACRIM AL DUCT IM PLANT , EACH • A4263 PERM ANENT , LONG TERM , NON-DISSOL VABLE LACRIM AL DUCT IM PLANT , EACH 11
J uly Webinar: Winning Carrier Appeals / Denied Claims Twelve steps to winning Carrier Denial Appeals. The review 1. 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.
Top Ten Medicare Part-B Claim Rejections 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 10. Where Services Furnished
Top Ten Medicare Part-B Denials (all specialties) 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 10. Timely Filing
S ample Denial scenario/ letter • State the facts. • Be clear on your credentials or background. • Be very specific on CPT , ICD-9 and HCPCS rules and guidelines. • Always reference M edical Necessity, M odifier rules, NCCI edits, the Bilateral Surgery M odifier and Global Days number as necessary. • Be clear that you know the Appeals Process. • The more informed you are (and appear) the more likely you will get paid.
Twelve Appeal S teps 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? 10. Is this worth appealing? Can you win? 11. Contact the carrier 12. Appeal as many times (levels) as necessary to get paid.
August Webinar: S trategies how to Audit-Proof your documentation EyeCodingForum.com • Strategies • Comprehensive Review of Documentation. • Compliance Plan. 17 • Don’t worry about Red Flags (next slide) • Action Plan • All files will be included in a zipped file e-mailed to you.
Y ou want to be an Outlier EyeCodingForum.com • Don’t worry about Red Flags • Y ou want to be an outlier if you are seeing 80 - 90% medical patients. 18 • M ore diagnostic procedures. • M ore high-level codes (level IV E & M ) • A lot more revenue. Y ou will still sell glasses. • What do you need to make all this happen?
Office Visit Exam Four Levels (for E & M Codes) Total Elements = 12 plus 2. Same exam elements for 990xx and 920xx exams. Always match the tests performed to the appropriate level code. 19 EyeCodingForum.com
Examination Components - Eye Selecting Exam Elements For the Eye Exam Perform and Document Level of Exam 1 – 5 exam items from checklist Problem Focused (99212/99201) Expanded Problem Focused 6 exam items from checklist (99213/99202) 9 exam items from checklist Detailed (99214/99203) All 12 Eye and at least 1 (of 2) Comprehensive (99215/99204 / Neurological/Psychological 99205) EyeCodingForum.com 20
Examination Components - Eye Selecting Exam Elements (14) - Example PF 1-5 EPF 6 Det 9 Comp 12+ 1 1. VA 1 1 1 1 2. CF 1 1 1 3. EOM 1 1 1 4. Conjunctiva 1 1 1 5. Pupils/ I ris 1 1 6. I OP 1 1 1 1 7. Adnexa 1 1 1 1 8. Cornea 1 1 9. Lens 1 1 10. A/ C 1 1 11. Disks (Dil.) 1 12. Retina (Dil.) 1 13. A+ OX3 1 1 1 1 14. Mood 1 1 1 1 EyeCodingForum.com 21
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