Article Date: 9/1/2006

billing & coding
Coding Resources

There's a wealth of information to help you with coding questions.

It 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.

Must haves

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 ( 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 information.

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

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.


Optometric Management, Issue: September 2006