Coding Information - Alabama Academy of Ophthalmology

127 Pages·2014·3.52 MB·English

by  Kim Ross

AAO Coding Update
Sue Vicchrilli, COT, OCS
AAO Coding Executive
2014 S.E. Eye Annual Regional Meeting: July 24-26, 2014
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AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
Financial Disclosure
 Sue Vicchrilli, COT, OCS
• Has no financial interests or
relationships relative to this live activity
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to disclose.
AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
Overview
 While the physician is ultimately
responsible, it takes a team of experts to
correctly
• Schedule the appointment,
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• Document and code the encounter,
• Preauthorize,
• Collect copayments, deductible,
• Submit the claim,
• Process the remittance advice
• Monthly statements/work collections

AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
Best Practice - Technicians
 Technicians must be proficient in
knowing the following in addition to your
technical skills:
• Guidelines for E/M and Eye codes
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◦ The importance of the chief complaint
◦ Does the CC identify what the physician needs
to know and have a minimum of 4 elements to
the HPI?
◦ Established patients – the status of 3 chronic
or inactive conditions

AMERICA N ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
Best Practice - Technicians
• Are exams performed the same day as
tests/minor/major surgery payable?
• Key words not to write:
◦ Preop
◦ Postop
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◦ Routine – unless a vision exam
• ROS
◦ New patient a minimum of 10 systems
◦ Established patient as medically necessary
◦ Any system with a positive answer has details of
what the patient is doing presently to care for that
problem

AMERICA N ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
Best Practice - Technicians
• PFSH
◦ All three on new patients
– Including children
◦ As medically necessary for established
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patients
• Testing services
◦ Which are unilateral vs. bilateral
◦ Written order for delegation
◦ Interpretation and report

AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
Best Practice - Technicians
• Surgeries
◦ Payable per lid, eye, lesion?
◦ CCI edits for same day surgery
• Modifiers
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◦ Exams
◦ Tests
◦ Surgery
– Procedures performed in the global period

AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
Best Practice - Technicians
• Advance Beneficiary Notice (ABN)
◦ Part B patients only
◦ Append modifier –GA to claim
– Alerts Medicare Part B that signed ABN is in
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your office
◦ Frequency of test
◦ Covered diagnosis
◦ Oculoplastic procedures

AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
Best Practice - Administrators
 PECOS
 All physicians who enrolled with Medicare Part B
prior to March 25, 2011, will be required to
revalidate their Medicare enrollment.
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 Physicians have 60 days from the date of the
revalidation notice to submit their complete
enrollment information.
 You will receive a revalidation letter through the
mail when it is your turn.

AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
Best Practice - Administrators
 PECOS
 Be proactive and re-enroll now.
 Delay?
• No payment! 00
• Lengthy re-enrollment process
• Pediatric ophthalmologists who do not
submit a claim to Medicare Part B within a
calendar year are automatically dropped
from Part B participation.

AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES