Webinar Bundle: Billing for Ophthalmology and Optometry Training

This Bundle focuses on billing for Eyecare.

  1. Dec 2016: New Everything for Eyecare – 2017: CPT, Medicare, HCPCS and More
  2. March 2014 Over 35 Key Concepts Every Provider, Coder, and Biller Must Know
  3. Jan 2015 Establishing Fees for Services
  4. June 2016 Medical Necessity
  5. May 2016 Winning Carrier Appeals
  6. Apr 2016 Medicare Advantage
  7. Aug 28 2014 Coding For Medicaid
  8. July 30 2014 Medicare for Eyecare
  9. Oct 2016: Basics of Coding, Billing, and Insurance
  10. Nov 2015 Maximizing Revenue for Ophthalmology and Optometry

In addition to eight billing-related modules, we include the basic coding, billing and insurance module and the 2017 CPT updates module at no additional cost.

All recorded videos are by clinic for up to 10 providers. They can be watched as often as you like. Every year older modules will be updated. They are about 50 minutes each and can be paused and rewound like any video. They are streaming Webinars on the WebEx server. After you purchase the Bundle you will see a link in your subscription area with the list above.

Click on this link to Order EyeCodingForum Services.

South Carolina legislators override veto of Eye Care Consumer Protection Law

On May 18, by a 39 to 3 vote, the Senate approved the veto override while the House voted a day later to override, 98 to 1, according to a press release by the AOA.

With support from the American Optometric Association, the South Carolina Optometric Physicians Association and the South Carolina Medical Association, the bipartisan bill mandates that eye care kiosks and similar technologies be held accountable and provide the same standard of care that is expected of a qualified eye care physician, according to the release.

Source : www.AOA.org


Top Ten Misconceptions about ICD-10

As someone who has been teaching ICD-10 to doctors, coders, billers, and managers for over two years, I would like to dispel some of the most common misconceptions.

ICD-10 training will cost me lots of money. Most of the estimates are widely-inflated full absorption cost accounting techniques where they add up every minute you spend reviewing your coding. Most small clinics can learn ICD-10 in 6-12 hours, update their fee ticket, and coding practices for less than a tenth of the $87,000 amount bandied about.

All medical practices need to get a line of credit because most of the insurance companies will not be ready and will deny a majority of their claims. This is another example of selling fear. Most insurance companies are ready now. Firstcoast, the Medicare carrier in Florida, has already updated (Dec. 2014) all Local Coverage Determination’s (LCD’s) to ICD-10. While some small self-funded plans may have some growing pains, if everyone in the clinic is properly trained, this should not be a problem.

ICD-10 is primarily an administrative function. Send the billers and coders to trading so they can take care of everything. This is incorrect. ICD-10 is primarily a documentation issue–that means more specific documentation by the providers. All providers need 6-12 hours of training; most of the training will be basic coding and documentation instruction that they may never have learned in the first place. The goal of ICD-10 is improved documentation and reporting the complete story of the visit.

I don’t have time to write a book! This is the either/or fallacy and asking the provider to document controlled versus uncontrolled diabetes is not asking for a book–it’s good clinical care and documentation. If the providers are currently using a look-up program, fee ticket, or ICD-9 cheat sheet with numerous unspecific codes, then, yes, they will need to improve the accuracy and specificity of their documentation, but this is something that they should have been doing all along. There is a difference between wet and dry age-related macular degeneration (ARMD), internal and external ophthalmoplegia, and myopia and degenerative myopia. Monthly audits and phasing-in improved specificity over a period of months is the best strategy.

ICD-10 is a conspiracy  by the insurance companies to not pay me. Understanding basic coding and billing guidelines and applying them is another task that requires a minimal amount of training. I have been teaching coding and billing for over 20 years and still learn something new every day. All providers need to understand the significance of “carrier-specific” rules and the concept of medical necessity. Some carriers will very likely be more strict with claim edits and deny claims when two codes are required and not just one (secondary glaucoma for example). It will not be consistent, but gathering data to improve healthcare, manage costs, and determine what is most efficient healthcare  is the reason for ICD-10–not to deny your claim.

My practice management software vendor told me they would handle everything and I do not have to go to any training. There are ways you can test this. One is to submit two codes where the second one is an “Excludes 1” code. Was it rejected? Another is to report codes that require a second code (code also, code additional, code the underlying cause, code first). These guidelines are in the manual and if you don’t use the manual for all your coding it’s easy to miss these. Last, search for PVD or “posterior vitreous detachment”. These terms are not in ICD-9 nor ICD-10. Did your software find them? There are additional codes that do not have a crosswalk. What does your software recommend? Lookup capability does not substitute for proper training in guidelines and documentation.

There are hundreds of new, specific disease codes in ICD-10. Actually, there are less than a dozen new codes in ICD-10 for Eyecare. Yes, that is not a typo. In some specialties, such as infectious diseases, OB/GYN, and orthopedics, there are many new codes, new code combinations, and additional reporting requirements. In Eyecare there is now laterality; you must report most conditions as either right, left, or bilateral eyes. That will increase the number of codes approximately 4X. The other major changes relevant to Eyecare are: diabetes and diabetic retinopathies (now one combination code); glaucoma codes (stage codes and laterality are now one combination code); and accidents (now must be reported as initial, subsequent, or sequela). Most of the specificity is already in ICD-9.

I’ll wait until a month before the implementation date of Oct. 1 2015: Over 95% of an ICD-10 class is reviewing basic coding concepts, guidelines, anatomy and terminology. All of this can be used now. The doctors need to learn and focus on documentation requirements and the concepts. The coders and billers need to learn as much about the diseases as possible so they can effectively translate the doctor’s documentation into accurate codes. The two most common examples are: late effects and reporting both the location and reason for an accident. Most optometrists do not document or report these. A late effect is the subsequent effect from an prior injury or event. The statement “chronic conjunctivitis due to burns to the eye five years prior” requires two codes, not one. One for the chronic conjunctivitis and another to indicate that this is a “late effect.” In ICD-10 a late effect becomes a sequela and is coded with an “S” 7-th digit extension code. Concerning accidents, every patient with a corneal abrasion or foreign body in their eye should be asked where they were when it happened and what were they doing? If they were in a factory and working on a metal-working machine, then two additional codes should always be reported to indicate the location and reason. These concepts have been around for decades. They are nothing new but many clinics are not documenting or reporting them today.

ICD-10 is going to reduce my revenue. You can use ICD-10 to increase the profitability of your practice–particularly in optometry. Increasing the number of medical patients by 10, 25 or 50% will have a significant increase in income per patient. Increasing the suite of diseases you manage and implementing a long-range marketing and education program concerning diabetes, high-risk drugs that can affect the eyes, hypertension, ARMD, glaucoma, and collagen vascular disorders, will reap results in higher level codes, more procedures, and more reference for medical patients. I like to think of ICD-10 training as “spring cleaning” where the doctor, the coder/biller, and the manager learn what each one needs to know to do their job effectively. Most all clinics have errors in their fee ticket, are missing documentation, or use codes improperly; errors that can be fixed in less than 30 minutes with a simple audit. Use ICD-10 to update everything in your clinic. You will be surprised how little time it takes and how much it can improve the bottom line, not decrease it.

The insurance companies don’t need all this detail. Remember, the data you send does not stop at the insurance carrier. It is further analyzed by the World Health Organization (WHO), the Center for Disease Control (CDC) and used worldwide for research to improve healthcare. The data is used to:

  1. Aid in the development of fee schedules and pricing schemes.
  2. Help in managing the utilization review process.
  3. Provide an opportunity for greater measurement of the quality and efficacy of medical care.
  4. Background for research.
  5. Allow additional codes for some categories (infectious diseases) that have run out of room for new codes.

ICD-10 is the “right thing to do.” If any provider, at any time, has said they became a medical professional because they wanted to help people, then that is yet another reason to implement ICD-10. It will help people. The data gathered will be used to fund research and improve healthcare worldwide.

Do not delay your ICD-10 training. Do note that some training is a lot better than others. If possible find specialty training that explains the diseases and conditions for all non-clinical staff. Also, there are numerous exceptions or “gotchas” as I call them. ICD-10 training should include at least a dozen; if not then they have not really  done their homework. The EyeCodingForum has a complete, six-hour  recorded ICD-10 training course for ophthalmology and optometry.

Jeffrey Restuccio, CPC, CPC-H, MBA
Coding Consultant
ICD-10 and Eyecare

Which Recorded Webinars do you Recommend?

If you need the basics in anatomy, CPT, ICD-9/ICD-10, E & M, office visits, diagnostic and minor surgical procedures, purchase the Maximizing Eyecare Revenue Course. If you are going to purchase just one, 4 or 8 Webinars, here is my sorted list with the best listed first. Click on the link for more information on a specific Webinar. You can copy and paste the Webinars listed below.

  1. NOV 2012: Optometry Coding and Billing Basics with specific Examples.
  2. April 2013: Top Errors, Misconceptions and Coding Questions for Eyecare.
  3. March 2013: Medical Necessity. Linking ICD-9 codes to office visits and procedures
  4. Jul 18, 2013: Eyecare Diagnostic Procedures Review
  5. JUL 2012: Winning Optometry Appeals Webinar.
  6. OCT 2012: Eyecare Coding and Billing for Medicare
  7. AUG 2012: How to Audit-Proof your Optometry Practice Webinar
  8. Aug 2013: ICD-10 Introduction
  9. Jun 2013: Answers to the Top Twenty Questions Most Eyecare professionals do not know.
  10. SEP 2012: Analyzing Fee Tickets for errors and lost revenue
  11. May 2013: Online, interactive audit of office visit notes (92014, 99214, 99203 and more).
  12. Oct 2013: ICD-10 Coding for Problems with Contact lenses
  13. DEC 2012: Marketing to medical patients in 2013.
  14. Dec 19, 2013: CPT Updates for Eyecare for 2014
  15. JUN 2012: Carrier-Specific Rules, E codes, Vitamin Therapy, ICD-10 and more.
  16. May 2012: Overview of common vision plans, feedback on 2012 codes, review of ICD-9 codes by CPT, ICD-10 and more.
  17. Sep 2013: Physicians Quality Reporting System (PQRS)
  18. Nov 14, 2013: TBA


What are some of the ICD-10 changes for Ophthalmology and Optometry?

Specific ICD-10 Concepts and Guidelines relevant to Coding correctly for Eyecare (Ophthalmology and Optometry)

  • Specific detailed review of top Eyecare conditions such as glaucoma, cataracts, DES, ARMD, retinal conditions and injuries.
  • Review of common Eyecare acronyms and how they translate to ICD-10
  • Review of bilateral and non-bilateral codes
  • Eyelid ICD-10 codes
  • Relevant codes not reported by eye.
  • Signs and symptoms codes not specifically Eyecare
  • Injuries and accident codes
  • Top peripheral codes applicable to Eyecare such as diabetes and hypertension.
  • Late Effect Codes are now listed as “Sequela.”
  • Foreign Body Codes

These are all covered in the EyeCodingForum ICD-10 Coding online Webinar. (six hours) It is recorded and available anytime. Order Here.


20 Coding Questions most Optometrists cannot answer

Below are 20 questions most optometrists, ophthalmologists (and most coding consultants) won’t be able to answer correctly (most are not simple yes or no answers). Our complete, online course plus our monthly webinars provide accurate and the best answer for the questions below:

  1. Is dilation required for the 92004 and 92014 codes?
  2. What elements are required for the comprehensive exam (920xx)?
  3. How many total elements are available for the exam (astounding how many optometrists don’t know this answer)
  4. What code is used for a routine vision exam?
  5. What is the number one reason one should not report a 92004 or 92014 code?
  6. When will a medical insurance carrier pay on code 92015 if they do not provide refractive coverage?
  7. What is a carrier-specific rule?
  8. Should you use modifiers E1-E4 with epilation?
  9. What is MOD-GY for and is it required?
  10. How do I submit a co-management claim for the cataract surgery for the second eye during the global period of the first?
  11. How do you report the removal of rust rings?
  12. What is an example of an incorrect use of modifier 25?
  13. How is modifier 59 used?
  14. Should I report codes 99050 and 99058?
  15. Which codes are inherently bilateral and where do I find this information?
  16. Which codes are paid 100% on each eye?
  17. Should I use S codes for discounts or a time-of-service discount?
  18. I have 100 denied claims; what would happen if I re-filed all of them without any changes?
  19. What is the main issue with pachymetry?
  20. What are the most common reasons for denials on post-cataract glasses?

We will probably use this list as a future Webinar in 2013.

– Jeff