billing & coding
Coding for Clinical Technology
How to bill for the use of new instrumentation.
CARLA
MACK, O.D.
As
a profession, I feel we optometrists are beginning to understand the value of our
services and also that we are taking the steps necessary to ensure we are coding
and billing correctly.
Still,
I often feel like a broken record when I repeat phrases such as, "bill appropriately
for each visit," or "you must count up the number of exam elements that you performed,"
or, one of my favorite lines that I often use when teaching optometry interns, "when
was the last time you had an appointment with a medical doctor and you expected
or received care free of charge?"
|
Coding for Clinical Technology |
|
*Corneal Pachymetry |
76514 |
B |
|
|
**Corneal Topography or
Unlisted Ophthalmologic Procedure |
92499 (RT, LT) |
M |
|
Diagnostic Imaging
(GDx, HRT, OCT) |
92135 (RT, LT) |
M |
I&R |
|
External Ocular
Photography |
92285 |
B |
I&R |
|
Fundus Photography |
92250 |
B |
I&R |
Ophthalmic Ultrasound
A-Scan Only, Quantitative |
76511 |
B |
|
|
Ophthalmic Ultrasound
B-Scan |
76512 |
B |
|
|
Visual Field Limited |
92081 |
B |
I&R |
|
Visual Field Intermediate |
92082 |
B |
I&R
|
|
Visual Field Extended |
92083 |
B |
I&R |
* Add -52 to bilateral procedures
performed unilaterally
**Corneal topography will get its own
CPT code in January 2007
M =
monocular
B =
binocular
I&R =
interpretation and report |
Spreading the word
Have you noticed how easy it has become to find
information on the business of optometry and how to incorporate medical optometry
and billing into your practice? I have several journal supplements on coding and
billing for glaucoma, dry eye and even silicone hydrogel contact lenses on my desk
that I received in the last year that serve as excellent references. I also receive
several e-mail advertisements a week on continuing education conferences that are
promoting the integration of medical concepts with business and coding concepts.
Recently, I was reading a practice
management article on clinical technology by Gary Gerber, O.D. He astutely stated
that by incorporating new clinical technology into your practice, there are obvious
benefits to the care you provide to your patients. He also said these technologies
benefit your practice by improving the practice image. I agree with this wholeheartedly.
That article prompted me to
provide an update on how to code and get reimbursed when you incorporate new clinical
technology into your practice. Remember, billing consistently and appropriately
and having staff who are knowledgeable about the managed care plans for which you
are a provider will also improve your practice image.
Details, details
First, determine the correct CPT code assigned
to your new office instrumentation (see table 1). These codes are billable in addition
to your evaluation and management code (992XX) or other office visit code (comprehensive
eye exam or consultation codes). You must properly document medical necessity for
the additional testing in the patient's record when you are seeking insurance reimbursement.
Keep a record of statements like, "ordered nerve fiber layer analysis (GDX) due
to optic disc pallor in both eyes." An auditor will easily find and understand these
notes. Choose diagnosis codes that accompany and indicate medical necessity for
your procedure code. For example, it would be hard to justify the medical necessity
of performing corneal pachymetry with a retinal detachment diagnosis.
One or two?
Know if the procedure code is monocular or binocular.
Monocular codes are billed twice when performed binocularly or should be accompanied
by a -50 modifier. Add a -52 modifier to binocular codes performed monocularly.
Some procedures require additional medical record documentation consisting of interpretation
and a report of the data collected. For threshold visual field testing, this would
include whether the testing was reliable. It would also include a brief summary
of the threshold visual field printout. You can document this directly on the printout
kept in the medical record or in your examination notes.
Optometric Management, Issue: November 2006