billing & coding
a wealth of information to help you with coding questions.
seems that more and more eye care providers realize the importance of correct coding,
more specifically, medical coding, in their practices. Patients do not seek treatment
from their primary care providers and expect to receive services for free or with
discounts. They understand that co-payments are required on the day of service and
often before seeing the provider. Patients will perceive your practice as innovative
if you diagnose and treat their conditions. And correctly coding and billing for
those services inherently states that there is value in them. However, finding easy-to-understand
and easy-to-use coding information for you and your staff can be a daunting and
timely process. I'd like to share the resources that are most useful to my staff,
colleagues and myself.
First and foremost, I always recommend having
up-to-date CPT, ICD-9-CM and HCPCS reference books. All are available as single
guides or in packages on the Web sites of the American Optometric Association (AOA)
and American Medical Association (AMA). Peruse these sites for other useful reference
guides as well. Both the CPT and ICD books contain information beyond the specific
codes that is worth reading. The CPT book contains a full listing of modifiers and
useful guidelines for coding evaluation and management visits. The ICD-9-CM provides
a detailed introduction section that explains how to use the book, a summary of
code changes, symbols and notations as well as valid three-digit ICD codes. This
information takes just minutes to review but is valuable for both staff and doctors.
Another helpful resource is available from Primary
Eyecare Network (www.primaryeye.net). I have found their billing guide, "Medicare
Billing A-Z," to be one of the best resources for those who might be intimidated
by the Medicare Web site and want immediately understandable information at their
fingertips. This text is detailed enough to provide usable information, but is limited,
so referencing literally takes just minutes. Along with the guide are laminated
reference sheets with common diagnosis codes, a listing of unilateral and bilateral
procedure codes and modifiers, and punctal occlusion, epilation and co-management
Building a recipe
Often, I'm asked to provide a cookbook approach
to coding evaluation and management visits. My answer is always the same. You must
have a reference guide to verify your E/M level. You must determine the specific
level of history, level of examination and level of decision-making from a completed
patient record. E/M guides provide an efficient way (in just seconds) to ensure
that you have not over- or under-coded the visit. The AOA offers a reference card
or you can incorporate your own guide right onto your examination form.
You can use the Centers for Medicare
and Medicaid Services' (CMS) online Evaluation and Management Service Guide to
ensure that you understand the documentation guidelines. Within this guide you will
also find other helpful links to the CMS website. You can also order exam forms
and route sheets that contain pertinent coding information from online resources
such as www.pmi-eyes.com.
Lastly, don't forget to attend lectures
on coding at national and local conferences by certified coding experts and nationally-recognized
clinicians such as Charles Brownlow, O.D., John Rumpakis, O.D., John McGreal, O.D.
and D.C. Dean, O.D.
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: September 2006