Article

BUSINESS: CODING STRATEGY

CODING FOR CO-MANAGEMENT

Ensure high quality vision over the lifetime of your patients

Co-management is an essential part of the care O.D.s provide. With the increase of technology in the IOL arena, consumer demand — based on more active lifestyles — and an upbeat economy provide the backdrop for a robust level of clinical activity in this area.

THE RELATIONSHIP IS KEY

The relationship between a surgeon and a co-managing physician is a formal one that begins with the referral to a surgeon. This formal transfer of care means the surgeon now “owns” the patient for this episode of clinical care. Who provides the co-management, or post-surgical care, is neither up to the surgeon nor the doctor who referred the patient to the surgeon; this decision belongs to the patient. There must be documentation within the medical record stating that the patient has requested to return to the referring physician for their post-op care.

Co-management, as defined by CMS, begins with the transfer of care from the surgeon to the co-managing physician, which is often, but not always, the physician who referred the patient to the surgeon. Keep in mind one critical thing – the initial referral to the surgeon cannot be based on a requirement or condition that the surgeon refer the patient back to the referring physician. It is, therefore, helpful to have a discussion with the patient about your desire to provide continued care following her surgery and that she is able to request that in discussions with the surgeon.

CODING ISN’T COMPLICATED

The coding for the co-management portion of care isn’t complicated (See “Coding for IOLs”); but you have to understand what you are providing. The global period for cataract surgery is 90 calendar days post-operatively with “Day 1” being the first day after surgery. During this period of time, you are providing office visits to follow-up the post-operative surgical management of the patient. Refractions are not included in this and should be coded and billed to the patient separately. Additional clinical tests, such as a post-operative OCT, must meet the clinical standards of medical necessity, are coded and billed separately and are not included in the post-operative global payment.

Communicating with the surgeon’s office is critical to be successful in reimbursement. Items, such as the date of release from the surgeon and the date of the assumption of care, must match the surgeons claim form. The number of days/units often must be delineated so you are reimbursed for the proportionate amount of care. Tip: Variations from carrier to carrier can be frustrating when submitting claims, so find out from the carriers that you are contracted with how the claims must be submitted.

CODING FOR IOLS

MONOFOCAL

→ 6698X-55-RT/LT for the first eye

→ 6698X-79-55-RT/LT for the second eye

→ Modifier -55 indicates that you are providing post-operative care only

→ Modifier -RT/LT indicates the eye that you are providing care for

→ Modifier -79 indicates that you are performing post-operative care for an unrelated procedure in the global period of the first procedure

Tip: Use the ICD-10 cataract diagnosis that the surgeon used when billing for the cataract surgery throughout the comanagement period.

PREMIUM IOLS

Use the following code descriptors to bill the patient directly:

Tip: Make sure to use the ICD-10 code for presbyopia along with this code.

→ Toric IOL. V2787: Astigmatism correcting function of IOL.

Tip: Make sure that you use the appropriate ICD-10 code for astigmatism along with this code.

→ Multifocal Toric IOL. Follow the guidelines for a multifocal IOL described above.

→ When working with premium IOLs, it is generally prudent that no money be paid from the surgeon to the co-managing physician. It is a best practice to have the patient pay each entity separately for their respective portion of the care provided: one payment to the surgical center, one to the surgeon and one to the co-managing physician.

BUILDING LASTING RELATIONSHIPS

Co-management services are a vital part of eye care. It is an opportunity to build relationships, with your patients and with ophthalmic surgeons, and revenues, such as managing pre-operative ocular surface disease, in your practice. Don’t shy away because of the perceived difficulty with coding of this care, but embrace it as you guide your patients toward achieving the best outcomes. OM