Understanding Medicare Guidelines 2008 John A Mc Greal

Understanding Medicare Guidelines - 2008 John A. Mc. Greal Jr. , O. D. Missouri Eye Associates Mc. Greal Educational Institute Excellence in Optometric Education

John A. Mc. Greal Jr. , O. D. Missouri Eye Associates n 11710 Old Ballas Rd. n St. Louis, MO. 63141 n 314. 569. 2020 n 314. 569. 1596 FAX n jamod 1@aol. com n JAM

2008 Medicare E/M Guidelines n Compliance – – – – How To Document the Medical Record How To Select an E/M Codes, eye codes, “S” codes How To Evaluate your Fees How To Effectively Co-manage Surgical Cases How To Increase Revenues How To Survive an Audit How To Understand HIPPA Privacy Rules How To Implement a Compliance Plan JAM

Health Insurance Portability and Accountability Act of 1996 n President Clinton & USAG J. Reno – – – – #2 priority: prosecution of health care fraud $104 Million: Appropriations to HHS $70 Million: OIG $47 Million: FBI fraud investigation unit Criminal offenses expanded $10, 000 fine / line item violation suspension of payment and participation from program Yielded $23 return on every $1 spent in 1997 JAM

Qui Tam Relaters Amendment to False Claims Act of 1986 n Encourages private individuals to sue in the government’s behalf n Whistleblowers - 30% of recoveries n – n $1 Billion paid since 1987 in Qui Tam actions Compliance Plan – – – Eliminates aggressive or conservative billing philosophies Removes incentives for whistleblowers Improves collections while reducing audit risks JAM

Medicare Review Strategies - 2008 Error rates at below 7% nationally n E/M codes represent 75% of errors (highest for Part B) n – – 10 -1 overpayment –underpayment Insufficient documentation and incorrect coding OB/GYN specialty highest error rate nationally at 35. 75% n Diagnostic radiology specialty highest projected dollars paid incorrectly at 48 million n JAM

Top 5 Errors by Profession - 2006 OB/GYN n Neurology n Chiropractic n n. Optometry – 11. 6% n Nephrology JAM

Medicare Review Strategies - 2008 E/M established codes n Laboratory n Hospital E/M, subsequent n Consultation codes n E/M new codes n Electrocardiograms n Chiropractic n Rituximab n Hospital E/M, initial n JAM

HIPAA in Bite Sized Chunks Standards for transactions conducted electronically n Standards to protect privacy of personal health information n Standards to protect security of personal health information when stored electronically n Uniform federal identifiers of providers, health plan, employers and individuals n JAM

NPI Identifier n Enumerator / National Provider System / ANSI – – n n Identifiers for providers, health plans, employers and individuals National Provider Identifier (NPI) – – n Must be used by May 23, 2007 Providers need to apply online at CMS website 10 digit string of alphanumeric characters, includes check digit Format allows 200 billion identifiers without re-using values Benefits of NPI identifiers – – – All transactions for ALL health plans NPI will never change Facilitates coordination of benefits Facilitates tracking claims and payments Facilitates identifying and prosecuting fraud JAM

Code Set Adoption in HIPAA CPT-4: Current Procedure Terminology n CDT: Code on Dental Procedures and Nomenclature n ICD-9 -CM (Volume 1, 2): International Classification of Diseases (Proposal to implement ICD-10) n ICD-9 -CM (Volume 3): inpatient disease codes n NDC: National Drug Code n HCPCS: Healthcare Common Procedure Coding System JAM n

INTRODUCTION n CMS = Center for Medicare & Medicaid Services (formerly HCFA) - announced June 14, 2001 – – – Center for Medicare Management - traditional feefor-service programs Center for Beneficiary Choices - provide beneficiaries with information on Medicare, Medicare. Select, Medicare+Choice, and Medigap options Center for Medicaid and State Operations - focus on Medicaid and state administered services JAM

INTRODUCTION CMS n CPT n ICD n – www. icd 9 coding 1. com/flashcode/user. Register. do Medicare n Major Medical n E/M Coding (99 XXX) n Eye Coding (92 XXX) n Special Ophthalmic Codes n JAM

E/M GUIDELINES New/Established Patient n Chief Complaint n History of Present Illness n Family History n Past History n Social History n Review of Systems n JAM

E/M DESCRIPTORS History * n Examination* n Medical Decision Making* n Counseling n Coordination of Care n Nature of the Presenting Problem n Time n JAM

CATEGORIES OF SERVICE n Office Visits (E/M Codes) – – n 99201 -99205 99211 -99215 Office Visits (Eye Codes) – – n New Estab 92002 -92004 92012 -92014 Consultations (E/M Codes) – Office 99241 -99245 JAM

E/M Coding - Consultation n Office Consultations – – Opinion / Advice Not Referral Duration - short n Continuity - expect patient back n Documentation - required n JAM

E/M Coding - Referral n Referral – Treatment or Care Duration - long n Continuity - Do not expect patient back n Documentation - not required, but courtesy n Warning! - carefully consider the language used in the correspondence to your consulting specialists n – avoid the term referral, unless that is what you mean! JAM

SELECTING AN E/M LEVEL Identify Category of Service n Identify Extent of History Taking n Identify Extent of Examination n Identify Complexity of Medical Decision Making n Review E/M Descriptors n JAM

E/M CODING - OFFICE VISITS n New Patient (3 of 3) – 99201 - PFH / PFE / SDM / 10 – 99202 - EFH / DFE / SDM / 20 – 99203 - DH / DE / LDM / 30 – 99204 - CH / CE / MDM / 45 – 99205 - CD /CE / HDM / 60 JAM

E/M Coding - Office Visits n Established Patient (2 of 3) – 99211 - Minimal / 5 – 99212 - PFH / PFE / SDM / 10 – 99213 - EFH / EFE / LDM / 15 – 99214 - DH / DE / MDM / 25 – 99215 - CH / CE / HDM / 40 JAM

DOCUMENTATION OF HISTORY n n Problem Focused History (PFH) – CC / 1 -3 HPI Expanded Problem Focused History (EPF) – CC / 1 -3 HPI / Ocular ROS Detailed History (DH) – CC / 4 HPI / Ocular ROS / ROS-2 / 1 OF 3 PFSH Comprehensive History (CH) – CC / 4 HPI / Ocular ROS / ROS-10 / 3 OF 3 PFSH (NEW) OR 2 OF 3 PFSH (ESTAB) JAM

Eye Examination Documentation VA / CVF / Pupils & Iris / Adnexa n Bulbar & Palp Conjunctiva n EOM n SLE: Cornea / Lens /AC n IOP / Optic Nerve / Posterior Segment n Neurologic: Orientation (Time / Place / Person) n Psychiatric: Mood & Affect (Depression /Anxiety /Agitation) n JAM

DOCUMENTATION OF EXAMINATION Problem Focused Exam (PFE) – Limited Exam / l - 5 Elements n Expanded Problem Focused Exam (EPF) – Limited Exam / 6 Elements n Detailed Exam (DE) – Extended Exam / 9 Elements n Comprehensive Exam (CE) – Complete Single System Exam – All Elements n JAM

Medical Decision Making n n Straightforward (SF) – # Dx / Rx Options - Min / Data - Min / Risk - Min Low Complexity (LC) – # Dx / Rx Options - Lim / Data - Lim / Risk - Low Moderate Complexity (MC) – # Dx / Rx Options - Mult / Data - Mod / Risk -Mod High Complexity (HC) – # Dx / Rx Options - Ext / Data - Ext / Risk - High JAM

Comprehensive Ophthalmological Service 92004 / 92014 n Complete system evaluation, 8 or more elements Need not be performed at one session n Integrated services where med decision making cannot be separated from examination methods n Includes history, medical observation, external & ophthalmoscopic, gross visual fields, sensorimotor, biomicroscopy, consultations, dilation (cycloplegia), mydriasis, tonometry, initiation of diagnosis and treatment programs, prescription of medication n

Comprehensive Ophthalmological Service 92004/92014 n Always includes initiation of diagnosis and treatment programs – includes the prescription of medication, and arranging for special ophthalmological diagnostic / treatment services, consultations, laboratory procedures and radiological services JAM

Intermediate Ophthalmological Service 92002 / 92012 Evaluation of new / existing condition, complicated with a new diagnostic or management problem n Integrated services where med decision making cannot be separated from examination methods n Includes history, medical observation, external & adnexal, & other diagnostic procedures, biomicroscopy, mydriasis ophthalmoscopy and tonometry n JAM

Intermediate Ophthalmological Service 92002 / 92012 n Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient n 7 or less elements JAM

2004 New HCPCS Codes “S” codes are useful for some private insurers n Medicare and other federal payers do not recognize them n They are useful when CPT does not have a code to accurately describe the service (i. e. LASIK, PTK, PRK, corneal topography) or for invoicing self-pay patients. n n They specifically describe “routine exams” including refractions and permit a different charge JAM

HCPCS “S” Codes S 0592 n S 0620 n n S 0621 Complicated contact lens evaluation Routine ophthalmologic exam including refraction; new patient Routine ophthalmologic exam including refraction; established patient JAM

2006 Medicare Fee Schedule Office Visits n n n n 99201 99202 99203 99204 99205 $34. 23$60. 83$90. 58$128. 26$163. 20 - 99211 99212 99213 99214 99215 $19. 96$35. 96$49. 10$77. 08$112. 36 - 92002 92004 $66. 03$120. 51 - 92012 92014 $60. 50$89. 53 JAM

2006 Medicare Fee Schedule Consultations 99241 n 99242 n 99243 n 99244 n 99245 n $46. 96$86. 00$114. 67$162. 01$209. 65 - JAM

Refraction 92015 Non-covered service n Can be billed to beneficiary n – n failure to do so results in lost revenues Reminders – – Charge only for “Rx-able” refractions Do not forget to charge for the final refraction when changing spectacles in a post-operative cataract patient JAM

Gonioscopy 92020 Bilateral n Requires documentation n – describe visible angle structures No limitations to diagnostic groups in most states n Fee $23. 12 - / $25. 47 n JAM

Visual Field 9208 x Bilateral n Requires Interpretation n – – separate report form narrative in body of medical record, on date of service Fee $44. 77 - (-81) / $46. 18 n Fee $58. 29 - (-82) / $59. 09 n Fee $66. 96 - (-83) / $68. 17 n JAM

Oculus Easy Field Perimeter n Screening AND Threshold fields n Color LCD-Display n Fixation monitoring – CCD camera n Stores up to 40, 000 exams n Built-in printer

Extended Ophthalmoscopy 92225 / 92226 Unilateral n Initial (-225) vs. Subsequent (-226) n Implies detailed, extra ophthalmoscopy n – document fundus lenses used Modifiers RT /LT n Requires retinal drawings & interpretation n – n sizes, colors and dimensions carrier specific Fee 92225 ($20. 38 -/$21. 69) 92226 ($18. 61/$19. 53) JAM

Fundus Photography 92250 n n Bilateral Not Bundled Requires Interpretation Fee $65. 86 -/$69. 46 JAM

Fundus Retinal Photos ROI n n n Synemed (Canon 8+MP) Cost $22, 500. 00 Lease $500. 00 Breakeven 2 photos / wk 8 -10 MP digital nonmydriatic 10 images / wk – lease = $22, 273. 20 annual revenue

2006 New ICD-9 Codes n n n Must report with 250. 5 362. 03 Nonproliferative diabetic retinopathy NOS 362. 04 Mild nonproliferative diabetic retinopathy 362. 05 Moderate nonproliferative diabetic retinopathy 362. 06 Severe nonproliferative diabetic retinopathy 362. 07 Diabetic macular edema – Must report with ICD code for diabetic retinopathy n 362. 01 = background diabetic retinopathy n 362. 02 = proliferative diabetic retinopathy n 362. 03 – 362. 07 JAM

External Ocular Photography 92285 n Report for documentation of medical progress – Ex. : close-up photography, slit lamp photography, goniophotography, stereo-photography Bilateral n Not Bundled n Requires Interpretation and report n Fee $39. 77 -/$42. 12 n JAM

RPS Adeno. Detector 87809 n n Bilateral Infectious agent detection by immunoassay with direct observation, not otherwise specified Modifier: QW for CLIA waived products ICD-9 Positive test result – – n ICD-9 Negative test result – – n 077. 3 other adenoviral conjunctivitis; acute follicular conj 077. 99 other diseases of conjunctiva due to viruses 372. 02 Acute follicular conjunctivitis, excludes EKC, PCF 372. 05 Acute atopic conjunctivitis Fee $16. 76 JAM

Serial Tonometry 92100 Bilateral n Requires Interpretation & Report n – – n Example: Angle closure glaucoma multiple measurements over time Fee $76. 05 -/80. 60 JAM

Scanning Computerized Ophthalmic Diagnostic Imaging 92135 n n Unilateral Applies to glaucoma and retinal evaluations – – – n n Heidelberg / Heidelberg Retinal Topography (HRT III) Carl Zeiss / Optical Coherence Tomography (OCT) Carl Zeiss / Laser Diagnostic Technology (GDX) Marco / Retinal Thickness Analyzer (RTA) Optovue / RTVue Requires Interpretation & report Fee $38. 91 -/$40. 64 JAM

Scanning Laser Covered Diagnosis List n n n n n 362. 85 retinal nerve fiber bundle defects 377. 00 -377. 04 364. 22 glaucomatocyclitic crisis Papilledema 364. 53 pigmentary iris degeneration 364. 73 goniosynechiae 364. 74 pupillary membranes 364. 77 recession of the angle 365. 00 -365. 9 glaucoma 368. 40 -368. 45 visual field defects 377. 9 unspecified disorder of optic nerve or pathways JAM

Scanning Laser 92135 n Moderate Damage - payable once or twice per year, not with a field – Visual field examples moderate reduction in retinal sensitivity n temporal wedge n – Optic Nerve examples n enlarged cup with sloped or pale rim n focal notch n rim/disc >0. 1 but <0. 2 n prominent lamina cribrosa JAM

Scanning Laser 92135 n Advanced Damage - rarely payable, fields more valuable – Visual field examples n loss of central vision n temporal island remains n severe reduction in retinal sensitivity n absolute defects to within 3 degrees of fixation – Optic Nerve examples n rim destroyed n rim/disc ratio<0. 1 JAM

Pachymetry 76514 Bilateral n Measurement of central corneal thickness (CCT) proven by Ocular Hypertension Treatment Study (OHTS) to be standard of care in diagnosis and management of glaucoma, glaucoma suspect and ocular hypertension n Also billable for keratoconus, corneal transplants, cataracts with corneal dystrophies, guttata, edema n Requires Interpretation & Report n Fee $11. 18 -/$11. 42 n JAM

Reichert IOPac n Portable n Battery operated n Stores up to 1000 pts. n USB and infrared interface n Down load to PC and printer n Detachable probe – Easily replaced if necessary – 888 849 8955

Computerized Corneal Topography 92025 Bilateral or unilateral n Requires interpretation & report n No limitations to diagnostic groups in most states n Fee $23. 12 - / $28. 47 n JAM

92025 Corneal Topography n ICD-9 Codes that Support Medical Necessity – – – – 367. 22* Irregular astigmatism 371. 00 Corneal Opacity Unspecified 371. 23 Bullous Keratopathy 371. 50 Hereditary Corneal Dystrophy Unspecified 371. 52 Other Anterior Corneal Dystrophy 371. 57 Endothelial Corneal Dystrophy 371. 60 Keratoconus Unspecified 371. 61 Keratoconus Stable Condition JAM

92025 Corneal Topography n ICD-9 Codes that Support Medical Necessity – 371. 62 Keratoconus Acute Hydrops – 372. 40 Pterygium Unspecified – 996. 51 Mechanical Complication Prosthetic Corneal Graft – V 42. 5 Cornea Replaced by Transplant – V 45. 61* Cataract Extraction Status – V 45. 69* Other States Following Surgery of Eye /Adnexa – *367. 22 must be accompanied by V 45. 61 or V 45. 69 – *V 45. 61 must be accompanied by 367. 22 – *V 45. 69 must be accompanied by 367. 22 JAM

Therapeutic Contact Lens 92070 Unilateral n Bundled with 92 xxx, includes supply of lens n Recommendations n – – – n use disposable lenses accept a less than optimum cosmetic fit tolerate debris on and beneath lens remove only once and do not replace liberally hydrate prior to removal Fee $58. 93 -/62. 97 JAM

Correction Trichiasis 67820* Epilation n By forceps n ICD-9 n – – n 374. 05 Trichiasis without entropion 374. 01 Senile entropion Fee $43. 79 -/$54. 29 JAM

Removal of Foreign Body 65205* n External Eye, Conjunctiva – – n ICD-9 – n superficial scleral, non-perforating 930. 18 FB in cul-de-sac Fee $45. 52 -$48. 82 JAM

Removal of Foreign Body 65210* n External Eye, Conjunctiva – – – n ICD-9 – n embedded (includes concretions) subconjunctival scleral, non-perforating 930. 18 FB in other sites or combined sites Fee $55. 64 -$59. 74 JAM

Removal of Foreign Body 65222* n External Eye, Corneal – n ICD-9 – n with Slit Lamp 930. 0 FB in cornea Fee $61. 25 -/$65. 75 JAM

Sensorimotor Examination 92060 n Quantitative measurement of ocular deviation – document all major fields of gaze Bilateral n Requires interpretation and report n Fee $48. 93 n 92065 – Orthoptic and / or pleoptic training, with continuing medical direction and evaluation n Fee $33. 78+/$32. 38 n JAM

Dilation of Lacrimal Puncta 68801* With or Without Irrigation n ICD-9 n – – n 375. 22 Epiphora, insufficiency of drainage 375. 42 Chronic Dacryocystitis 375. 52 Stenosis, Lacrimal Punctum 375. 56 Nasolacrimal Duct Obstruction Fee $98. 07 -/$103. 08 JAM

Punctal Occlusion By Plug 68761 Temporary (collagen) or Permanent (Silicone) n Payment is per puncta (modifiers required) n – – E 1=left upper E 2=left lower E 3=right upper E 4=right lower Global period - 10 days n Supply code-included in procedure code, not separately billable n Fee $120. 91 -/$130. 02 n JAM

Punctal Occlusion By Plug 68761 n ICD-9 – – – – – 370. 21 Punctate Keratitis 370. 23 Filamentary Keratitis 370. 34 Exposure Keratitis 370. 80 Other forms of Keratitis 370. 90 Unspecified Keratitis 371. 42 Recurrent Corneal Erosion 374. 41 Eyelid Retraction 375. 15 Unspecified Tear Film Insufficiency 710. 20 Sicca Syndrome; use additional systemic JAM manif. code

Modifiers – – – – – 32 Mandated Services 50 Bilateral Procedure 24 Unrelated Service / Same Doctor 25 Separate Service / Same Doctor / Same Day 52 Reduced Service / Informational / Not Reduced Fee 54 Surgical Care Only 55 Post-Op Care Only 51 Multiple Procedures RT / LT Right / Left E 1 - E 4 Identifies Puncta JAM

Comanagement of Surgery Procedures / 66984 / $594. 76 -/$639. 69 n Global Periods - usually 90 days n Value - up to 20% n Modifiers (-54, -55) n Range Dates n Rules - Medicare Transfer Agreement in MD record n Correspondence n Legal/Political/Inter-professional Issues JAM n

Complicated Cataract Surgery 66982 New CPT code for 2001 / $832. 60 -/$850. 80 n Extracapsular cataract extraction with insertion of IOL, complex, requiring devices or techniques not generally used in routine cataract surgery n – 2% of all cataract surgeries involve extraordinary work n iris expansion devices, suture support for IOL, posterior capsulorrhexis, small pupil, subluxed lens, Pseudoexfoliation, trauma, Marfan’s, glaucoma, uveitis n pediatric population n Advanced, white, hard cataract JAM

CASE 1: Cataract n CPT / ICD – – – 92015 / Myopia (367. 1) = $20. 00 99203 / Cataract (366. 16) = $95. 00 Total $115. 00 Rx: Spectacles n RTO: 1 YR n CPT / ICD n – – – 92015 / Myopia (367. 1) = $20. 00 99214 / Cataract (366. 16) = $80. 00 Total $100. 00 JAM

CASE 2: Blepharoconjunctivitis n CPT / ICD – 99213 or 92012 / Blepharitis (373. 00) = $50. 00 or $63. 00 Rx: Bacitracin Oint hs / Tobradex qid / Lid Hygiene / AFTs n RTO: 1 WK n CPT / ICD n – – 99212 / Blepharitis (373. 00) = $$45. 00 Total $95. 00 or $108. 00 JAM

CASE 3: Allergic Conjunctivitis n CPT / ICD – – 99213 or 92012 / Conjunctivitis allergic (372. 14) $50. 00 or $63. 00 Rx: Pataday QD / Cold Packs / AFTs n RTO: 1 WK n CPT / ICD n – – 99212 or 92012 / Conjunctivitis, allergic (372. 14) = $$45. 00 or $63. 00 Total $95. 00 or $126. 00 JAM

CASE 4: Rosacea (Skin & Eye) n CPT / ICD – – – 99213 or 92012 Meibomianitis (373. 12) / Acne Rosacea (695. 30) = $50. 00 or $63. 00 92285 / (370. 01) Marginal keratitis = $45. 00 Total $ 95. 00 or $108. 00 Rx: Zylet QID / Lid Hygiene / Minocycline 50 mg BID / Metro. Cream 0. 75% BID RTO: 2 D n CPT / ICD n – – 99212 or 99213 / Meimbomianitis (373. 12) = $50. 00 or$63. 00 Total $145. 00 or 171. 00 JAM

CASE 5: Corneal Foreign Body n CPT / ICD – – 99213 -25 / Abrasion (918. 1) = $50. 00 99285 / Abrasion (918. 1) = $45. 00 65222 / Corneal Foreign Body (930. 00) = $65. 00 Total $ 160. 00 Rx: Acular LS QID / Zymar QID / Patch +/Ibuprofen 400 mg n RTO: 1 Day n JAM

CASE 6: Misdirected Lashes n CPT / ICD – – 99213 -25 / SPK (370. 21) = $50. 00 92285 / SPK (370. 21) = $45. 00 67820/ Trichiasis (374. 05) = $45. 00 Total $140. 00 Rx: Xibrom BID / AFTs n RTO: 1 Day / PRN n JAM

CASE 7: Corneal Erosion n CPT / ICD – – – 99213 / Recurrent Corneal Erosion (371. 42) = $50. 00 92070 / Recurrent Corneal Erosion (371. 42) = $70. 00 Total $120. 00 Rx: Vigamox TID / Nevanac TID / Bandage SCL n RTO: 1 Day n CPT / ICD n – – 99212 or 92012 / Recurrent Corneal Erosion (371. 42) = $45. 00 or $63. 00 Total $165. 00 or $183. 00 JAM

CASE 8: Bacterial Keratitis n CPT / ICD – – – 99213 or 92012 / Bacterial Keratitis (370. 03) = $50. 00 or $63. 00 92285 / Bacterial Keratitis (370. 03) = $45. 00 Total $95. 00 or $108. 00 Rx: Zymar q 2 h n RTO: 1 Day n E/M: 99212 or 99213 or…. . ? n – Total $145. 00 and up JAM

CASE 9: Central Serous Retinopathy n CPT / ICD – – n n 99213 / Central serous retinopathy (362. 41) = $50. 00 92225 -LT / Central serous retinopathy (362. 41) = $20. 00 92250 / Central serous retinopathy (362. 41) = $70. 00 Total $140. 00 Rx: Observation RTO: 1 Mos CPT / ICD – – 99213 / Central serous retinopathy (362. 41) = $50. 00 92226 -LT / Central serous retinopathy (362. 41) = $20. 00 92135 -LT / Central serous retinopathy (362. 41) = $45. 00 Total $255. 00 JAM

CASE 10: Macular Degeneration n CPT / ICD – – 99203 / Age Related Macular Degeneration (362. 51) = $95. 92225 -RT, 92225 -LT / (362. 51) = $40. 00 92250 / (362. 51) = $70. 00 Total $205. 00 Rx: Amsler Grid / Vitamins n RTO: 6 Mos n CPT / ICD n – – 99212 / 92135 -RT, 92135 -LT / (362. 51) = $135. 00 Total $340. 00 JAM

CASE 11: High Risk Medication n CPT / ICD – – 99213 / Rheumatoid Arthritis (714. 0), High Risk Medical Treatment (V 58. 69) = $50. 00 92226 -RT, 92226 -LT / (714. 0, V 58. 69) = $40. 00 92083 / (714. 0, V 58. 69) = $70. 00 Total $160. 00 Rx: Observation n RTO: 6 Mos n CPT / ICD n – – Same as above = $160. 00 Total $320. 00 JAM

CASE 12: Dermatitis n CPT – – – / ICD 99213 or 92012 / Dermatitis (373. 32) = $50. 00 or $63. 00 92285 / (373. 32) = $45. 00 Total $95. 00 or $108 n Hydrocortisone 1. 0% QID / Cold Packs n RTO: 1 WK n CPT / ICD – – 99212 / (373. 32) = $45. 00 Total $140. 00 – $153. 00 JAM

CASE 13: Glaucoma Suspect n CPT / ICD – – – n 99214 / Glaucoma Suspect (365. 01) = $80. 00 92020 / (365. 01) = $25. 00 76514 / (365. 01) = $15. 00 92250 / (365. 01) = $70. 00 92083 / (365. 01) = $70. 00 99213 or 92012 / (365. 01) = $50. 00 or $63. 00 92235 -RT, 92235 -LT / (365. 01) = $90. 00 Total $400. 00 or $413. 00 Rx: Initiate or continue treatment or consultation. MD JAM

CASE 14: Dry Eye Dx: Documentation: Narrative & Shirmer Strips n CPT / ICD Temporary Collagen Plugs n – – n 99214 -25 / Dry Eye Syndrome (370. 33) = $80. 00 68761 -E 2 / (370. 33) = $125. 00 68761 -E 4 / (370. 33) = $125. 00 (Paid at 50% allowable) Total $267. 00 E/M: Permanent Silicone Plugs – 99212 -25, 68761 -E 2, 68761 -E 4 / (370. 33) = $227. 00 RTO: >10 Days global period n Total $494. 00 n JAM

CASE 15: Cataract Co-Management n CPT / ICD – – – 66984 -55, RT / 366. 16 Date of Service-is date of surgery Range Dates-starts on date of transfer of care from MD to OD, ends 90 days from date of surgery Rx: Post-Operative Care n RTO: Outcome dependant n E/M: 92015 and Material/Hardware Codes (DME) n JAM

Monitor Compliance with Audits n n Develop a “Documentation” team Monthly Assessment – n Report your Results – n 10 charts/Provider All staff, residents, students Acknowledge positive & negative variances – RETRAIN, RETRAIN. .

THANK YOU! n Primary Eyecare Network – 1. 800. 444. 9230 www. primaryeye. net – Medicare Compliance Kit n Health History Questionnaire n Examination Forms n E/M Worksheets n ICD-9 Codes n Interpretation/Report form – Medicare A-Z Manual – Superbills / Signature on File stickers / Electronic Claims – HIPAA Compliance Manual JAM

Thank you Missouri Eye Associates Mc. Greal Educational Institute Excellence in Optometric Education