Maximizing Revenue through Accurate Coding, Billing, Documentation, and Compliance

This Webinar is recorded and if you can watch it anytime, anywhere. If you select just one, this should be it. Note that it does assume a basic knowledge of concepts and guidelines. If you discover you need additional training, select our Beginner Bundle of Webinars (only $125) on our Order Form.

1. Documenting and reporting 920xx codes

2. Documenting and scoring E & M office visits

3. Know how to score MDM.

4. Updating your fee schedule. Understanding RVU’s

5. Understanding medical necessity

6. Medicare Guidelines and Tips

7. Learn how to appeal denied claims.

8. Reporting optimal levels (audit-proofing your clinic)

9. Knowing information not in the CPT manual (e.g., unilateral vs bilateral codes)

10. Work screenings for high-risk drugs

11. Niche markets: psychiatric, neurology, orthopedics, pediatrics

12. How to document the Interpretation and Report for diagnostic tests

13. A little something extra on ICD-10 (Appendix)

Workers Compensation and ICD-10

While healthcare providers and physicians may be scrambling to get ready for ICD-10, workers’ compensation practitioners are not required to switch to the new codes, according to the Workgroup for Electronic Data Interchange (WEDI), an advisor to the Department of Health and Human Services.

Approximately one-half of the Workers compensation claims systems are ready to switch to ICD-10 on October 1. About one-half, or 26 states will continue to use ICD-9 codes after Oct. 1 2015. Therefore your PM system will have to support switching between ICD-9 and ICD-10. Plus you staff has to be well-trained to avoid any confusion.

[Also: ICD-10 checklist: AHA releases step-by-step preparation guide]

WEDI has released data on worker’s compensation readiness by state. Twenty-one states have adopted ICD-10 billing for physicians, hospital inpatients and outpatients, according to WEDI.

ICD-10 ready: Alabama, California, Florida, Georgia, Hawaii, Idaho, Illinois, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Mexico, New York, North Carolina, Ohio, Oregon, South Dakota, Texas and Washington.

Three states have adopted ICD-10 codes for hospital inpatient billing only: Indiana, Maine and South Carolina.

[Also: With ICD-10 about a month away, healthcare providers say ‘bring it on’]

Continue with ICD-9: Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Hawaii, Iowa, Kansas, Kentucky, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Dakota, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Virginia, Wisconsin and Wyoming.

If you hear anything different please email me at ecf@eyecodingforum.com and we will update this post.

Glaucoma Stage Code Definitions: mild, moderate and severe

The stage coding is based on the Eyecare professional’s judgment. There are several different definitions of the stages, which will be summarized below.

Mild Damage — American Optometric Association Definition

  • Optic Nerve – mild concentric narrowing or partial localized narrowing of the neuroretinal rim; disc hemorrhage; cup/disc asymmetry
  • Nerve Fiber Layer – less bright reflex; fine striations to texture; large retinal blood vessels clear; medium retinal blood vessels less blurred; small retinal blood vessels blurred
  • Visual Field – isolated paracentral scotomas; partial arcuate or nasal step; damage limited to one hemifield with fewer than 25% of points involved, mean deviation (MD) less than -6 dB

Mild Damage — American Academy of Ophthalmology Definition

  • Optic nerve changes consistent with glaucoma but NO visual field abnormalities on any visual field test OR abnormalities present only on short-wave-length automated perimetry or frequency doubling perimetry

Mild Damage — CMS Definition

  • One or more of the following in the worst eye
  • Intraocular pressure >22mmHG
  • Symmetric or vertically elongated cup enlargement, neural rim intact, cup/disc ration > 0.4
  • Focal optic disc notch
  • Optic disc hemorrhage or history of optic disc hemorrhage
  • Nasal step or small paracentral or arcuate scotoma
  • Mild constriction of visual field isopters

Moderate Damage — American Optometric Association Definition

  • Optic Nerve – moderate concentric narrowing of the neuroretinal rim; increase in the area of central disc pallor; a complete localized notch or loss of the neuroretinal rim in one quadrant; undermining of vessels
  • Nerve fiber layer – minimal brightness to reflex; no texture; large, medium, and small retinal blood vessels clear
  • Visual field – partial or full arcuate scotoma in at least on hemifield; damage may involve both hemifields; fixation should not be involved; mean deviation between -6 dB and -12 dB

Moderate Damage — American Academy of Ophthalmology Definition

  • Optic nerve changes consistent with glaucoma AND glaucomatous visual field abnormalities in one hemifield and not within 5 degrees of fixation.

Moderate Damage — CMS Definition

  • One or more of the following in the worst eye
  • Enlarged optic cup with neural rim remaining but sloped or pale, cup/disc ration >0.5 but <0.9
  • Definite focal notch with thinning of the neural rim
  • Definite glaucoma visual field defect (arcuate/paracentral scotoma), nasal step, pencil wedge, constriction of isopters

Severe Damage — American Optometric Association Definition

  • Optic Nerve  – complete absence of the neroretinal rim in at least three quadrants; bayoneting of vessels; markedly increased area of central disc pallor
  • Nerve fiber layer – reflex dark; no texture; large, medium, and small retinal blood vessels clear
  • Visual field – advanced loss in both hemifields; 5-10 degrees central island of vision; mean deviation worse than -12 dB

Severe Damage — American Academy of Ophthalmolgy Definition

  • Optic nerve changes consistent with glaucoma AND glaucomatous visual field abnormalities in both hemifields and/or loss within 5 degrees of fixation in at least on hemifield.

Severe Damage — CMS Definition

  • One of more of the following in the worst eye
  • Severe generalized constriction of isopters
  • Absolute visual defects within 10 degree of fixation
  • Severe generalized reduction of retinal sensitivity
  • Loss of central visual acuity, with temporal island remaining
  • Diffuse enlargement of optic nerve cup, with cup to disc ratio >0.8
  • Wipeout of all or a portion of the neural retinal rim

If both of the patient’s eyes are glaucomatous, always report for the more severe stage of the two eyes. If the two eyes have different types of glaucoma, document each eye with its type and assign a stage code for each eye.

The indeterminate code would be used when you see a patient that you haven’t yet had time to do a visual field on, the patient just can’t perform a visual field test, or it’s so unreliable or uninterruptable that you really are unsure what level or state they are at.

Risk factors for glaucoma with borderline findings

H40.01*: Open angle with borderline finding, low risk (1-2 risk factors) [Code has laterality] (365.01)

H40.02*: Open angle with borderline findings, high risk (3 or more risk factors) [Code has laterality] (365.05)

The list below includes glaucoma risk factors according the Mayo Clinic:

Because chronic forms of glaucoma can destroy vision before any signs or symptoms are apparent, be aware of these factors:

Elevated internal eye pressure (intraocular pressure). If your internal eye pressure (intraocular pressure) is higher than normal, you’re at increased risk of developing glaucoma, though not everyone with elevated intraocular pressure develops the disease.

Age. You’re at a higher risk of glaucoma if you’re older than age 60, particularly if you’re Mexican-American. You may be at higher risk of angle-closure glaucoma if you’re older than age 40. For certain groups such as African-Americans, however, the risk of developing glaucoma is much higher and occurs at a younger age than that of other groups. If you’re African-American, ask your doctor when you should start having regular comprehensive eye exams.

Ethnic background. African-Americans older than age 40 have much higher risk of developing glaucoma than do whites (Caucasians). African-Americans also are more likely to experience permanent blindness as a result of glaucoma. People of Asian descent have an increased risk of developing acute angle-closure glaucoma. People of Japanese descent may be more likely to have normal-tension glaucoma.

Family history of glaucoma. If you have a family history of glaucoma, you have a greater risk of developing it. Glaucoma may have a genetic link, meaning there’s a defect in one or more genes that may cause certain individuals to be more susceptible to the disease. A form of juvenile open-angle glaucoma has been clearly linked to genetic abnormalities.

Medical conditions. Several conditions may increase your risk of developing glaucoma, including diabetes, heart diseases, high blood pressure and hypothyroidism.

Other eye conditions. Severe eye injuries can cause increased eye pressure. Other eye conditions that could cause increased risk of glaucoma include eye tumors, retinal detachment, eye inflammation and lens dislocation. Certain types of eye surgery also may trigger glaucoma. Also, being nearsighted or farsighted may increase your risk of developing glaucoma.

Long-term corticosteroid use. Using corticosteroid medications, especially eyedrops for a long period of time may increase your risk of developing secondary glaucoma.

 

August 28 ICD-10 Coding Questions for ophthalmology and optometry

Prepare for Oct 1 by working the 12 attached coding questions.

aug 28 questions

The answers are made available to our ECF ICD-10 clients (4-page form or comprehensive course).

We will package all ICD-10 questions for Eyecare shortly with the answer key.

August 21 ICD-10 Questions for ophthalmology and optometry

Prepare for Oct 1 by working the 12 attached coding questions.

Aug 21 questions

The answers are made available to our ECF ICD-10 clients (4-page form or comprehensive course).

We will package all ICD-10 questions for Eyecare shortly with the answer key.

Quick LCD list with ICD-10 Codes

WPS Medicare now offers their LCD’s with either ICD-9 or ICD-10 codes. You can compare and contrast both lists. Click here for a complete list.

 

 

 

 

Aug 21ICD-10 Coding Exercises for Eyecare

See the link below to download the PDF file of 12 questions for August 21 2015.

AUG 21 update coding exercises

Answers are provided to ICD-10 course, 4-page ICD-10 list, and all Site License EyeCodingForum clients.

Thanks for your support!

Aug 14 ICD-10 Coding Exercises for Eyecare

See the link below to download the PDF file.

Aug 14 Weekly ICD-10 coding examples for Eyecare – Questions Only 2015

Answers are provided to ICD-10 course, 4-page ICD-10 list, and all Site License EyeCodingForum clients.

Thanks!

August 7 ICD-10 Coding Exercises for Eyecare

August 7 2015 list of 12 ICD-10 coding exercises for optometry and ophthalmology. These follow our comprehensive, six-hour ICD-10 training program and our 4-page ICD-10 code list (aka “cheat sheet. Click on the link below to download the PDF.

Aug 7 Weekly ICD-10 coding examples for Eyecare Questions

The answer key and explanations will be supplied to all EyeCodingForum ICD-10 recorded training, 4-page ICD-10 code list and Site License customers. The EyeCodingForum staff has spent hundreds of hours preparing and educating thousands of Eyecare clinics nationwide. Let us worry about ICD-10 so you don’t have to. If you are not on our e-mail list enter your contact information here.

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Jeffrey Restuccio, CPC, CPC.
jeff@eyecodingforum.com
(901) 517-1705