Aug. 18 Webinar: Coding and Billing for post-cataract glasses

This 50-minute webinar will be held noon central time on Thursday,  Aug 18. It is only $49 and will be recorded so you can watch it anytime. This Webinar will be specific to ophthalmology and optometry (Eyecare).

This webinar will include numerous rules and guidelines concerning reporting services to the DME-MAC, or durable medical equipment, Medicare administrative contractor. It will cover eyeglasses, contacts and prosthetic eyes. This unique niche is either loved or hated by Eyecare professionals. Many have given up due to the increased paperwork and complexity. However, it is a valuable niche market if you have an optician or sales staff that is comfortable upselling patients on additional features.  This is an updated 2016 version from the EyeCodingForum comprehensive billing and coding course. In this webinar you will learn:

  1. What is DME-MAC?
  2. Basic reporting guidelines
  3. Specific HCPC codes
  4. How to streamline the process
  5. Upselling
  6. Marketing your services
  7. Carrier-specific rules
  8. DME-MAC modifiers
  9. Other supplies
  10. Tying it all together

This Webinar is included in our Site License or order a bundle of four for a 50 % discount. If you have any questions please be sure to send them to us beforehand:

Click here to Order.

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.

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!

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.

Click Here to Order EyeCodingForum Services.

Jeffrey Restuccio, CPC, CPC.
(901) 517-1705

ICD-10 Updates and Clarifications July 2015

Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities

JPR: The information below is from the Medicare document above.

As stated in the CMS’ Guidance, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family of codes. However, they are subject to specific LCD or NCD requirements.

JPR: I can think of few unspecified eye codes: ARMD, ectropion, scleritis, or amblyopia that would cause a denial. Most LCD’s for Eyecare include ranges of codes and do not exclude the “unspecified code.” As a certified coder, I am taught that the most specific codes and the group of codes that most accurately reflect the encounter, based on coding guidelines is the proper way to report the service.

For one, unspecific codes inform the world that the provider “does not know what is wrong with the patient.” Both the clinic manager and the provider should want to avoid this impression. While most won’t be able to be in the top ten-percent of clinics in terms of coding accuracy–you don’t want to be in the bottom 50% and certainly not the bottom 10-percent. Being specific, accurate, and following all coding guidelines is the best strategy to get paid, every time, and in all situations, by all carriers. Lastly, if the providers ever wanted to practice medicine because they wanted to help people, here is their opportunity. We need the specificity and additional status codes for research. Universities  worldwide are waiting on more specific data to help prevent and cure diseases. As I stated earlier, improve your diagnosis reporting because it’s the right thing to do.

In another example, a patient has a diagnosis of G43.711 (Chronic migraine without aura, intractable, with status migrainosus). Use of the valid codes G43.701 (Chronic migraine without aura) or G43.719 (Chronic migraine without aura, intractable without status migrainosus) instead of the correct code, G43.711, would not be cause for an audit under the audit flexibilities occurring for 12 months after ICD-10 implementation, since they are all in the same family of codes.

JPR: Most in Eyecare use the unspecific headache codes. I recommend, in my ICD-10 training that the provider report the headache more specifically as tension, migraine, ocular, retinal, etc…There is no way for the carrier to know which type of migraine the patient has and the auditor would actually have to review the notes and compare them to the specific code reported. Not all auditors do this so this would be a rare phenomenon.

Question 4: What should I do if my claim is rejected? Will I know whether it was rejected because it is not a valid code versus denied due to a lack of specificity required for a NCD or LCD or other claim edit?

Answer 4: Yes, submitters will know that it was rejected because it was not a valid code versus a denial for lack of specificity required for a NCD or LCD or other claim edit. Submitters should follow existing procedures for correcting and resubmitting rejected claims and issues related to denied claims.

Question 5: What is meant by a family of codes? (Revised 7/31/15)

Answer 5: “Family of codes” is the same as the ICD-10 three-character category. Codes within a category are clinically related and provide differences in capturing specific information on the type of condition. For instance, category H25 (Age-related cataract) contains a number of specific codes that capture information on the type of cataract as well as information on the eye involved. Examples include: H25.031 (Anterior subcapsular polar age-related cataract, right eye), which has six characters; H25.22 (Age-related cataract, morgagnian type, left eye), which has five characters; and H25.9 (Unspecified age-related cataract), which has four characters.

One must report a valid code and not a category number. In many instances, the code will require more than 3 characters in order to be valid.

The three official CMS documents are available to download below:




ICD-10 Implementation Plan for Eyecare

This free, three-page implementation is a succinct outline of an action plan for preparing for the October 1 ICD-10 deadline.

It is suitable for optometry and ophthalmology offices. It includes:

  1. Overview
  2. Action Items
  3. New to ICD-10 Concepts
  4. What to review starting now
  5. Data entry practice recomendations
  6. Basics
  7. ICD-10 concept review
  8. Reporting 2 codes when required (this is covered in detail in my ICD_10 training course)
  9. Documentation issues pertaining to specific diseases (covered in my online, recorded course)
  10. Injury coding
  11. Top 10 codes/code groups most clinics omit.
  12. List of six actual omitted codes
  13. 42 questions posted separately on the EyeCodingForum

Click on this link to enter  your information and download the free, three-page implementation form.

Click Here to Order EyeCodingForum Services

Four-Page ICD-10 Code Sheet for Eyecare

This form would be suitable for most ophthalmology and optometry offices that report a considerable number of medical diagnoses. For best results we recommend ordering it with our comprehensive ICD-10 training.

Click Here to Order

The form is $150 per copy and will be mailed to you so be sure to include your mailing address. It will be printed on 11X17 paper and folded in half, and includes just over 500 codes–more than any comparable form.

Form Features.

  1. Sorted by Type/Category and then alphabetically.
  2. The laterality codes sort properly in numeric order.
  3. We aggregated over a dozen actual clinics codes to create this form.
  4. Over 100 specific disease codes.
  5. Reviewed by the certified coders at the EyeCodingForum.
  6. Diabetic retinopathy codes (all of them) are available as a separate one-page form.
  7. This form took well over two weeks (80) hours to create. Plus it requires knowledge of both GEMS and MS Access database.
  8. Customization is available. This form can be customized for your clinic. We can change the order or format.
  9. We can add your codes. We can subtract codes.

If interested please order now as the deadline approaches our inquiries are increasing exponentially every month. The customization service is a minimum of $350 extra (essentially the same as the ICD-9 to ICD-10 code conversion service.) This upgrade includes up to 5 hours of custom conversion services. Additional formatting is billed at $65 per hour.

The sample is “watermarked” with red type. Your will be printed professional on card-stock paper.

June 6 SUN 4 page Cheat Sheet WM ICD-10 for Eyecare


How to Get started with ICD-10 training for ophthalmology and optometry TODAY

With our recorded, video training, you can train all your doctors (up to 10), and your staff for one low, discounted price. You can watch the videos anytime and as often as you want until Oct 1 2015. Recorded training is per clinic so it’s a great deal at any price. To get started:

Click Here to Order EyeCodingForum Services. On the form select either:

  1. The ICD-10 Training Course
  2. Combined ICD-10 plus the Maximizing coding and billing course.
  3. Site License option (special introductory price) which includes all recorded training: ICD-10, billing, plus over 35 recorded webinars. This is a phenomenal  offer so lock in this reduced price now.

Need testimonials? Click here.
Need an outline? Click here.
Need to see some examples? Click here for the ECF YouTube Channel.

After you purchase the course you will set up a User ID and password. Enter those on the subscription page and you should see a menu with all your training options and links. Click on the subscription link(s) on the left and enjoy the videos.

I have taught this ICD-10 class live over 100 times. I have 15-20 years experience as a coding instructor, and I’ve audited over 10,000 records. I specialize in eyecare. The training course is over seven hours and and covers over 100 diseases. No other course, and some are twice the price, comes close.

If you have any problems contact me at or call me at (901) 517-1705. Be specific exactly what the problem is. Most problems are best fixed through emails but the links above should solve 95% of problems.

Jeffrey Restuccio, CPC, COC, MBA


Status of ICD-10 for ophthalmology and optometry July 31 2014

To all Eyecare professionals, ophthalmologists, optometrists, coders, billers, and managers, the new due date for ICD-10 has been confirmed by Medicare: October 1 2015.

Do not wait until August or September of 2015 to begin your training. Most clinics are spending at least six hours reviewing their current codes and working on improving documentation now to prepare for ICD-10. Implementing ICD-10 is not a clerical function–it is mostly about documentation. Learning the actual codes is about 30% of the training. Translating the documentation to the codes is the other 70%. The EyeCodingForum offers a comprehensive, six-hour ICD-10 training course specifically for Eyecare.

A copy of the CMS Medicare Press Release is below.

Press release: Deadline for ICD-10 allows health care industry ample time to prepare for change

Date2014-07-31TitleDeadline for ICD-10 allows health care industry ample time to prepare for changeFor Immediate ReleaseThursday, July 31,
Deadline for ICD-10 allows health care industry ample time to prepare for change
Deadline set for October 1, 2015

The U.S. Department of Health and Human Services (HHS) issued a rule today finalizing Oct. 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. This deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015.

The ICD-10 codes on a claim are used to classify diagnoses and procedures on claims submitted to Medicare and private insurance payers. By enabling more detailed patient history coding, ICD-10 can help to better coordinate a patient’s care across providers and over time. ICD-10 improves quality measurement and reporting, facilitates the detection and prevention of fraud, waste, and abuse, and leads to greater accuracy of reimbursement for medical services. The code set’s granularity will improve data capture and analytics of public health surveillance and reporting, national quality reporting, research and data analysis, and provide detailed data to enhance health care delivery. Health care providers and specialty groups in the United States provided extensive input into the development of ICD-10, which includes more detailed codes for the conditions they treat and reflects advances in medicine and medical technology.

“ICD-10 codes will provide better support for patient care, and improve disease management, quality measurement and analytics,” said Marilyn Tavenner, Administrator of the Centers for Medicare & Medicaid Services (CMS). “For patients under the care of multiple providers, ICD-10 can help promote care coordination.”

Using ICD-10, doctors can capture much more information, meaning they can better understand important details about the patient’s health than with ICD-9-CM. Moreover, the level of detail that is provided for by ICD-10 means researchers and public health officials can better track diseases and health outcomes. ICD-10 reflects improved diagnosis of chronic illness and identifies underlying causes, complications of disease, and conditions that contribute to the complexity of a disease. Additionally, ICD-10 captures the severity and stage of diseases such as chronic kidney disease, diabetes, and asthma.

The previous revision, ICD-9-CM, contains outdated, obsolete terms that are inconsistent with current medical practice, new technology and preventive services.

ICD-10 represents a significant change that impacts the entire health care community. As such, much of the industry has already invested resources toward the implementation of ICD-10. CMS has implemented a comprehensive testing approach, including end-to-end testing in 2015, to help ensure providers are ready. While many providers, including physicians, hospitals, and health plans, have completed the necessary system changes to transition to ICD-10, the time offered by Congress and this rule ensure all providers are ready.

For additional information about ICD-10, please visit:

Here is the link to the Medicare website.

Wednesday July 30 EyecodingForum Webinar: Medicare for Eyecare

This noon, Central Time, 50-minute Webinar will focus on everything related to Medicare for both optometry and ophthalmology.  Note the live Webinar is Wednesday and not the usual Thursday. It will be recorded so you order and view anytime. We will discuss:

  1. Common diagnostic procedures
  2. The Basics (LCDs, E & M Guidelines, Incident-To Rules)
  3. How to work with Medicare
  4. Why Medicare is not just one, single  agency (jurisdictions)
  5. Co-Management
  6. Understand carrier-specific rules
  7. Office visits (both E & M and 920xx codes)
  8. Documentation requirements
  9. How to Appeal denied claims
  10. Preparing for ICD-10 in 2015.

Nationally, about 75 to 85% of Medicare rules and guidelines are the same. However, there are 12 Jurisdictions in the United States and each one has slightly different rules. Our goal will be to provide both a sound foundation and discuss new information from all of them and help you get paid correctly, the first time.

The Webinar is $49.00 for one or purchase a block of 4 for only $99. Click on this link to Order EyeCodingForum Services.