Oct 23 Webinar: Coding and Billing for Glaucoma Patients

This is a shortened version of the 90-minute presentation presented Nov 7 at the 2014 California Optometric Association Conference in Monterey CA.

On Thursday, October 23, noon, Central Time, the EyeCodingForum will present a 50-minute Webinar on everything related to coding and billing for glaucoma patients. You will learn important tips and tricks that will help you get paid correctly, the first time. This Webinar will be recorded so you can order and view the video anytime. This fee is per clinic, not per person. Click on this link to Order EyeCodingForum Services. It is the first item on the list. If you do not see this Webinar, then select the Recorded Webinars option and send us the month and year and we will send you the link. We will discuss the following:

  1. Ways to increase your revenue.
  2. Top documentation errors
  3. Report 992xx E & M codes or 920xx eye exam codes for glaucoma?
  4. Medical necessity
  5. Common diagnostic procedures.
  6. Coding for glaucoma patients in ICD-10
  7. Medicare and glaucoma patients
  8. Coding and Billing with other services
  9. Coding and Billing with other diseases
  10. Understanding carrier-specific rules
  11. MOD-59 and why you need to know this modifier
  12. Tips on appeals
  13. Your Questions!

The Webinar is $49.00 or purchase a block of 4 Webinars for only $99. At only $25 per webinar just one tip could return your investment in just one week! Click on this link to Order EyeCodingForum Services. Click on the EyeCodingForum link at the bottom to learn more about our services.

www.eyecodingforum.com

Does the chief complaint “lock you in?”

This is from a national Medicare Regulations and Guidance Transmittal dated August 8 2014. [The original link is here].

I’ve been asked, many times over the years, regarding the guidelines concerning the chief complaint for an Evaluation and Management office visit. While the specific example below does not refer to Eyecare, it is an official position on whether the provider can use a confirmed diagnosis when the patient presents with only signs and symptoms.

“For outpatient claims, providers report the full diagnosis code for the diagnosis shown to be chiefly responsible for the outpatient services. For instance, if a patient is seen on an outpatient basis for an evaluation of a symptom (e.g., cough) for which a definitive diagnosis is not made, the symptom is reported.  If, during the course of the outpatient evaluation and treatment, a definitive diagnosis is made (e.g., acute bronchitis), the definitive diagnosis is reported.”

Jeffrey Restuccio, CPC, CPC-H, MBA

EyeCodingForum.com

jeff@eyecodingforum.com

 

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, 2014Contactpress@cms.hhs.gov
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: http://www.cms.gov/ICD10

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.

 

 

 

 

Webinar Bundle – Beginner

This group of six 50-minute Webinars is suitable for a beginner to intermediate coder/biller in an optometrist or ophthalmologist office. The list price for all six Webinars is $294 ($49 each). For a limited time only, the price is $125. That is nearly six hours of training, a per-clinic fee (not per person) plus you can watch anytime and multiple times.

  1. June 2014 Top Documentation Errors
  2. April 2014 Coding and Documentation for Office Visits (992xx and 920xx)
  3. Mar 2014: 35 key concepts every EyeCare professional should know.
  4. Jul 18, 2013: Eyecare Diagnostic Procedures Review
  5. March 2013: Medical Necessity. Linking ICD-9 codes to office visits and procedures
  6. NOV 2012: Optometry Coding and Billing Basics with specific Examples.

Click on this link to Order EyeCodingForum Services.

It is the top option.

Trizetto Introduction to ICD-10 Coding for Eyecare

The 55-minute webinar, conducted by Jeffrey Restuccio, CPC, CPC-H, MBA, (author and narrator of the EyeCodingForum content) is now posted to the Trizetto website. It is free to review.

http://www.gatewayedi.com/icd10/webinars/icd-10-webinar-for-eyecare-professionals/

The EyeCodingForum offers a 6-hour (plus) training program for ICD-10. It is recorded video format and can be viewed anytime, multiple times, until Oct 1 2014.

Click the link below to order the EyeCodingForum six-hour version of the ICD-10 coding for Eyecare.

http://www.eyecodingforum.com/amember/signup.php

 

 

 

GEMS on Steroids by the EyeCodingForum

With the looming deadline of October 1 2014 for ICD-10 implementation, there will be hundreds teaching ICD-10 and offering ICD-9 to ICD-10 conversion services. How do you determine who is qualified? How do you distinguish someone who is knowledgeable about ICD-10 coding? And lastly how do you determine is truly knowledgeable about your specialty and can discuss the diseases and diseases on more than a superficial level?

Most advise to use the GEMS (General Equivalency Mapping) tool to crosswalk ICD-9 to the correct ICD-10 codes. Some organizations are charging $2500 for this GEMS conversion. The GEMS conversion files are available on the Medicare website but it requires knowledge of database design and manipulation to actually make this work. Plus, as you will see there is a lot of information that is missing from GEMS.

Below is the list of the top 27 ICD-9 codes from a typical Eyecare clinic used in our example. The complete EyeCodingForum ICD-9 to ICD-10 service is explained here. I call the service. Send us your list of ICD-9 codes for a free analysis. The complete analysis is 21 pages and you can download it for free at this link GEMS on Steroids by the EyeCodingForum Dec 1 2013.

Rank

ICD-9

Description

1

36721

Regular Astigmatism

2

3671

Myopia

3

3674

Presbyopia

4

3670

Hypermetropia

5

36616

Senile nuclear sclerosis

6

36504

Ocular hypertension

7

36615

Cortical senile cataract

9

36511

Primary open angle glaucoma

9

36511

Primary open angle glaucoma

9

36511

Primary open angle glaucoma

9

36511

Primary open angle glaucoma

9

36511

Primary open angle glaucoma

10

37300

Blepharitis unspecified

11

2245

Benign neoplasm of retina

12

37200

Acute conjunctivitis unspecified

13

37272

Conjunctival hemorrhage

14

37311

Hordeolum externum

16

25000

Diabetes mellitus without complication type II or unspecified   type not stated as uncontrolled

17

36614

Posterior subcapsular polar senile cataract

19

37515

Tear film insufficiency unspecified

20

36250

Macular degeneration (senile) of retina unspecified

21

36257

Drusen (degenerative) of retina

22

36500

Preglaucoma unspecified

23

36502

Anatomical narrow angle borderline glaucoma

24

36510

Open-angle glaucoma unspecified

24

36510

Open-angle glaucoma unspecified

24

36510

Open-angle glaucoma unspecified

24

36510

Open-angle glaucoma unspecified

24

36510

Open-angle glaucoma unspecified

27

37210

Chronic conjunctivitis unspecified

 

2014 Live Cross Country Seminars for ICD-10 training for ophthalmology and optometry

I will be teaching ICD-10 coding for Ophthalmology and Optometry in 2014/2015 in over 60 cities for Cross Country Education (CC). Contact Cross Country Education for live seminar availability. Phone number is 800.397.0180. E-mail is customerservice@CrossCountryEducation.com

The EyeCodingForum, separately, offers an expanded version of the ICD-10 training in video format (PowerPoint slides plus narration), which is available today. The cost is per clinic (up to 10 providers)–not per person so you can save a significant amount of money if you have a large clinic. Click here to order.

Live CrossCountryEducation Seminars

Speaker Code

Seminar City

Seminar Date

Jeffrey Restuccio Bakersfield

10/28/2014

Jeffrey Restuccio Fresno

10/29/2014

Jeffrey Restuccio San Jose

10/30/2014

Jeffrey Restuccio Reno

11/11/2014

Jeffrey Restuccio Sacramento

11/12/2014

Jeffrey Restuccio San Francisco

11/13/2014

Jeffrey Restuccio Shreveport

12/09/2014

Jeffrey Restuccio Dallas

12/10/2014

Jeffrey Restuccio Little Rock

12/11/2014

Jeffrey Restuccio TBA

01/13/2015

Jeffrey Restuccio TBA

01/14/2015

Jeffrey Restuccio TBA

01/15/2015

Jeffrey Restuccio TBA

01/27/2015

Jeffrey Restuccio TBA

01/28/2015

Jeffrey Restuccio TBA

01/29/2015

Feb 10 11 12

Feb 24 25 26

Mar 9 10 11 12

Mar 23 24 25 26

The live experience is fundamentally different from the recorded version. We will have a class where over half of the participants will be optometrists and ophthalmologists.  My classes are interactive and we expect spirited interaction between the requirements of the coders and billers and the clinical staff. [Click here for more on What's the Difference?]

The live class is a unique opportunity to ask a qualified, certified coder, with over 15 years of experience and a thorough background in Eyecare, virtually any coding and billing question. Due to the high level of interactivity of my live seminars, I will have to remove about 60 minutes of information from the live seminar that is in the recorded version. In the live seminar we will have the opportunity to discuss the “real world” of selecting and documenting specific ICD-10 codes with your peer group. We will mostly likely discuss well over 100 specific eye diseases and conditions and their related codes. I have spent well over 200 hours preparing this training course. I have trained well over 1,000 certified coders, and taught over 185 coding and billing seminars for Eyecare. There will not be anything quite like this ICD-10 coding training for Ophthalmology and Optometry, anywhere, by anyone.

Jeffrey Restuccio, CPC, CPC-H

Eyecare coding and billing consultant

jeff@eyecodingforum.com

(901) 517-1705

Completed cities in 2014 are below (I may not return in 2015; recommend the recorded, video six-hour ICD-10 Training Course.

Norfolk VA Tuesday Feb 18 2014
Raleigh NC Wednesday Feb 19 2014
Charlotte NC Thursday Feb 20 2014
Columbia SC Tuesday Jan 28 2014
Savannah GA Wednesday Jan 29 2014
Jacksonville FL Thursday Jan 30 2014
Wilkes Barre 3/11/2014
Harrisburg 3/12/2014
Philadelphia 3/13/2014
Atlantic City 3/25/2014
Edison 3/26/2014
Parsippany 3/27/2014
Portland 4/8/2014
Spokane 4/9/2014
Seattle 4/10/2014
Salt Lake City 4/22/2014
Denver 4/23/2014
Billings 4/24/2014
Grand Rapids 5/6/2014
Ft Wayne 5/7/2014
Indianapolis 5/8/2014
Columbus 5/20/2014
Toledo 5/21/2014
Sterling Heights 5/22/2014
San Antonio 6/10/2014
Austin 6/11/2014
Houston 6/12/2014
PEORIA Tuesday, June 24, 2014
DAVENPORT Wednesday, June 25, 2014
MADISON Thursday, June 26, 2014
APPLETON Tuesday, July 08, 2014
MILWAUKEE Wednesday, July 09, 2014
SCHAUMBURG Thursday, July 10, 2014
Providence RI Tuesday, July 22, 2014
Worcester MA Wednesday, July 23, 2014
Hartford CT Thursday, July 24, 2014
Jeffrey Restuccio Arlington

9/2/2014

Jeffrey Restuccio Hagerstown

9/3/2014

Jeffrey Restuccio Baltimore

9/4/2014

Jeffrey Restuccio Syracuse

9/16/2014

Jeffrey Restuccio Albany

9/17/2014

Jeffrey Restuccio White Plains

9/18/2014

Jeffrey Restuccio Orlando

10/14/2014

Jeffrey Restuccio Ft Myers

10/15/2014

Jeffrey Restuccio Miami

10/16/2014

 

 

ICD-9 to ICD-10 Conversion Service for Eyecare

The EyeCodingForum is now offering an ICD-9 to ICD-10 code conversion service.

Click on this link to Order this service.

I have checked other, competing services and most perform a generic GEMS conversion for about $2500. Understanding all the rules, codes, disease options, and making critical decisions concerning which codes to include and which to exclude is not a trivial task. The EyeCodingForum staff has spent well over 200 hours studying and preparing our ICD-10 for Eyecare training course. Plus we have been teaching medical coding and billing for over 15 years.

The EyeCodingForum service is personalized, customized, and Eyecare specific. This includes the six-hour ICD-10 training for your entire staff. We anticipate and fix any areas of vagueness or uncertainty from your ICD-10 code selection. With the expansion of codes in ICD-10 it is simply impossible to get even a marginally correct list of codes on even two pages. Decisions have to be made. The first question is do you want to code to the highest level of specificity and properly report codes using ICD-10 guidelines? If the answer is yes, we can help.

Send us a list of either your top 200 codes or the codes from your current fee ticket in a either text or Excel spreadsheet format. We provide multiple options:

  1. A customized ICD-10 code list with approximately 150 codes (3 columns of 50) per page.
  2. One or two page option (can be any length)
  3. Your list of codes and names
  4. Updated disease or condition descriptions
  5. Fix any current ICD-9 errors
  6. Fix all vague descriptions/unspecific ICD-9 codes
  7. Optional removal of unspecific diseases, eye or eyelid codes.
  8. Add in required or missing diseases/codes
  9. Expand to all relevant ICD-10 codes
  10. Options for listing laterality, eyelid codes, occurrence codes, and glaucoma stage codes.
  11. Options for listing diabetes codes (well over 100)
  12. Option for printing wildcards and a 6th & 7th digit legend.
  13. Up to 4 hours of conference calls/webinars with the doctors and staff.
  14. Audit of up to 20 encounters for documentation errors/improvements.
  15. Options for proper injury coding: sequela (late effects), injury (S and T codes), Place of Injury (W and Y codes).
  16. Hundreds of alternative, common names for conditions not found in the ICD-10 manual.
  17. Expert advice on codes that do not have an ICD-10  crosswalk.
  18. One year of EyeCodingForum Webinars (2014) including at least ½ dozen on specific ICD-10 issues.
  19. The complete, six-hour, ICD-10 coding for Eyecare online (recorded) course (worth $225)
  20. Over one-hundred medical subterms of lesser-known diseases defined.
  21. Access to the EyeCodingForum expert staff.
  22. Peace of Mind. Take advantage of our expertise and economies of scale. We will perform hundreds of conversions in the next 12 months. We can do it faster, better, and less expensively than you could do it yourself. We go to all the bother and reinvent the wheel?

Our introductory fee for the custom conversion service above is $1200. The $500 option is a  conversion of your current ICD-9 codes to ICD-10 plus a list of additional codes I would recommend. It does not include the other services and the iterative consulting portion above.

There will be a lower-fee, conversion-only option for single provider optometry clinics.

If you are interested in knowing the current quality of your ICD-9 code list and how many ICD-10 codes it will expand into, please send it, with your contact information, to ecf@eyecodingforum.com in a  spreadsheet format. Be sure to list the ICD-9 codes as text so they do not truncate fifth digits (.00). In addition to your current fee ticket list, be sure to send your top reported ICD-9 codes for a year (generated from your practice management system). There is no fee for this preliminary evaluation.

Thank You

Jeffrey Restuccio
jeff@eyecodingforum.com
www.eyecodingforum.com

 

Is there an ICD-11?

Believe it or not, there is already an update to ICD-10, in beta version, known as ICD-11. I found this trying to determine why does ICD-10 have two separate codes for diplopia and double vision whereas everyone considers these to be synonymous. This is the type of question that keeps me up late at night. Technically one should not document one “double vision” (H53.19) and then report the ICD-10 code for diplopia: H53.2.

You can see an example of ICD-11 below (note how it combines both in one code and references back to H43.2 or diplopia and not double vision):

8D30.3 Diplopia

Parent:  8D30 Visual disturbances     ICD-10 : H53.2
Definition: This is pathologically perceiving double vision of a single object as a result of impaired function of the extraocular muscles.

Inclusions •Double vision

All Index Terms

•Diplopia
•Double vision
•seeing double
•vision; double vision

More information is found at the World Health Organization website:

http://apps.who.int/classifications/icd11/browse/l-m/en#!/http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F184960545