billing & coding
Common Coding and Billing Errors
Discovering your mistakes can help you prevent
them in the future.
the past two years, I have overseen the coding and billing procedures of our high-volume
student health optometry services at the Ohio State University. Our situation at
Ohio State is unique: We are a teaching facility with 40-50 attending doctors, 30
clinic staff and 90-150 rotating student interns providing care at any given time.
like to share our three most common coding and billing errors in hopes of helping
you improve your procedures:
By far, our number one coding error has been under-coding.
By this, I mean billing a problem-focused evaluation and management (E/M) office
visit at a level lower than what the patient history, examination and decision-making
support. For example: An established patient presents with a red, irritated right
eye after repeatedly sleeping in a soft contact lens not approved for extended wear.
A detailed history, expanded problem-focused examination, and mod- erately complex
decision-making are appropriately documented in the medical record and support the
patient's primary complaint of the red, painful eye. The visit should be coded as
an established E/M level three (99213); however, it is billed as a level two (99212).
Under-coding by one E/M level will result in a loss of approximately $30 per visit
under the medicare fee schedule.
Our second most common coding and billing error
relates to our most common error, but takes under-coding a step further to lack
of coding. There are a number of ophthalmic procedures that are billable in addition
to the office visit or evaluation and management visit. Corneal topography (92499),
gonioscopy (92020), diagnostic imaging (92135), pachymetry (76514), anterior and
posterior segment photography (92285 and 92250 respectively) and threshold visual
field testing (92083) can be billed separately, and in addition to, the office visit
when the procedure is medically necessary.
Through careful record review, we discovered
that while we performed and appropriately recorded billable ophthalmic testing many
times, we did not complete the process by billing the patient or the patient's medical
insurance for the testing. There is also confusion over whether to bill some procedures
as bilateral or unilateral. A bilateral procedure is performed on both eyes, but
billed once. Threshold visual fields (code 92083) is one example. When you perform
a unilateral procedure bilaterally, bill twice with the appropriate –RT and
–LT modifiers, or with the -50 modifier. An example of a unilateral procedure
code is scanning laser diagnostic imaging, 92135.
office procedures accurately means:
unilateral versus bilateral codes
the interpretation and report
accurate modifiers, RT, LT, O.U., -50, -52
Thirdly, in some cases we over-code an examination
by billing a level of service such as an E/M level 4, when our medical record documentation
supports an E/M level 3. In most of these over-coding situations, we found that
the level of service had been performed, but not appropriately documented or in
some cases, documented at all. If you take a history or perform testing and don't
record it, it is as if you never performed it at all.
Discovering our most common coding
and billing errors was the first step to correcting them. Our staff, doctors and
interns understand the importance of correct coding as it relates to practice management
and the overall value of the services that we provide.
DR. MACK IS DIRECTOR
OF CLINICS AT THE OHIO STATE UNIVERSITY COLLEGE
OF OPTOMETRY. SEND E-MAIL TO CMACK@OPTOMETRY.OSU.EDU.
Optometric Management, Issue: January 2006