May 19 Webinar: Winning Carrier Appeals the First Time

This 50-minute webinar will be held noon central time on Thursday,  May 19. It is only $49 and will be recorded so you can watch it anytime. This Webinar will be specific to ophthalmology and optometry (Eyecare). It will include:

  1. Most common reason claims are denied
  2. Top Ten Medicare Part-B reasons
  3. Sample Denial letters
  4. Appeal Steps
  5. Get Organized before you call
  6. Identify the Carrier / Gather the manual or LCD.
  7. Is this a non-covered service?
  8. Is pre-authorization always required?
  9. ICD-10 Linking
  10. NCCI Edit?
  11. Correct Modifier?
  12. Is this a Carrier-Specific Rule?
  13. Is this worth appealing? Can you win?
  14. Contacting the carrier
  15. Appeal as many times (levels) as necessary to get paid.
  16. The art of appealing a denied claim.

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: jeff@eyecodingforum.com

Click here to Order.

April 21Webinar: Understanding Medicare Advantage and Eyecare

This 50-minute webinar will be held on Thursday, April 21, at noon central time. It is only $49 and will be recorded so you can watch it anytime.

This Webinar will be specific to ophthalmology and optometry (Eyecare). It will include:

  1. Overview of the Medicare Advantage (Part-C) program
  2. How is it the same as Part-B?
  3. How is it different from Part-B?
  4. Who are the specific vendors?
  5. What is a “carrier-specific” rule?
  6. How can I get paid the first time, every time?
  7. How do I appeal?
  8. Specific Eyecare CPT codes
  9. And of course Your Questions

If you have any questions please be sure to send them to me beforehand: jeff@eyecodingforum.com

Click here to Order.

Mar 24 Everything Not in the CPT or ICD-10 Manual

This webinar is specifically for Eyecare and covers the following:

  1. The PFSRVU database
  2. RVUS
  3. Professional versus Technical component
  4. E & M RVU’s versus 920xx codes
  5. Bilateral surgery modifier
  6. Other surgery flags
  7. NCCI Edits
  8. Global Days
  9. Local Coverage Determination
  10. Medical Necessity
  11. Medicare Modifiers
  12. Eye Exam elements
  13. Other Issues
  14. AHA ICD-10 Coding Guidelines for 2016

Click here to Order. All Webinars are recorded and watched anytime.

Feb 18 Webinar: Coding Compliance for Eyecare Part II

Next Webinar:  Thursday, February 18, 2016: Compliance for Eyecare Part II.

All Webinars are at noon, central time and recorded. You can watch anytime. We had so much additional information from the January webinar that we decided to conduct another Compliance Webinar–Part II.

We may even have a third compliance webinar. We will see. If you have never attended an EyeCodingForum Webinar before this series should be your first. It is definitely worth a few hours of your time.  Click Here to Order the Webinar Now.

In Coding Compliance for Eyecare, Part II we will cover:

  1. Cloned Notes and EMR
  2. Medical Decision Making (MDM) for E & M encounters
  3. Miscellaneous Concepts
  4. Insurance carriers
  5. What is a routine vision exam?
  6. Interpretation and Report
  7. Select diagnostic procedures
  8. Analyzing weighted averages
  9. Screenings
  10. Screening for Plaquenil and other drugs
  11. Obstacles to Compliance
  12. Information not in the CPT manual
  13. Bonus: example of ICD-10 specificity: Prepare for Oct 1 2016

Remember that Part I, below was recorded so you can watch it anytime. I highly recommend this compliance series. You can select both for only $90 on the order form.

  1. Basic concepts of coding compliance with an emphasis on Eyecare issues.
  2. Specific examples and areas to focus on.
  3. Office visits
  4. Diagnostic tests
  5. Surgical procedures
  6. Performing a weighted-average analysis of top services
  7. The audit/train/audit feedback loop.
  8. The 12 top compliance errors.
  9. Why baseline training for the staff and providers is necessary.
  10. The features of a good coding compliance plan.
  11. A review of an actual coding compliance plan.
  12. Why implementing good compliance measures will take far less time than you think.
  13. The concept of risk assessment and how much risk your clinic wants to assume.
  14. How improving compliance will improve your bottom line.
  15. And of course your questions.

Click Here to Order the Webinar Now.

Each Webinar is $49 or buy a block of 4 for $99; they are included with the Site License (over 40 Webinars and ICD-10 updates for a full year) for only $499. Click here for a list of available Webinars.

The EyeCodingForum.com’s Coding Compliance Plan for Eyecare ($200) will not be included with this $49 Webinar. However, all participants will have the option of purchasing it for 1/2 price ($100). This 38-page plan would cost you well over $1,000 from any large consulting firm. It represents about a week’s worth of research.

Jeffrey Restuccio, CPC, COC, MBA

EyeCodingForum Consultant

Jan 28 Webinar – Coding Compliance for optometry and ophthalmology

This EyeCodingForum Webinar was on ThursdayJanuary 28, noon central time, fifty-minutes. It is now recorded so you can watch it anytime.

This is an updated version and consolidation of numerous Webinars we have conducted in the past. But it is the first one focused entirely on coding compliance for optometry and ophthalmology. In my 20-plus years of consulting this is the one topic most organizations allow to slip through the cracks–plus it is the most difficult to implement internally because you must be strict with the doctors and there is often pushback.

We will cover:

  1. Basic concepts of coding compliance with an emphasis on Eyecare issues.
  2. Specific examples and areas to focus on.
  3. Office visits
  4. Diagnostic tests
  5. Surgical procedures
  6. Performing a weighted-average analysis of top services
  7. The audit/train/audit feedback loop.
  8. The 12 top compliance errors.
  9. Why baseline training for the staff and providers is necessary.
  10. The features of a good coding compliance plan.
  11. A review of an actual coding compliance plan.
  12. Why implementing good compliance measures will take far less time than you think.
  13. The concept of risk assessment and how much risk your clinic wants to assume.
  14. How improving compliance will improve your bottom line.
  15. And of course your questions.

Click Here to Order the Webinar Now.

Each Webinar is $49 or buy a block of 4 for $99; they are included with the Site License (over 44 Webinars and ICD-10 updates for a full year) for only $499. Click here for a list of available Webinars.

 

Meaningful Use and Coding Compliance

Meaningful Use and Coding Compliance, Thu, Nov 19, 2015, noon central time, fifty-minutes.

This will be a detailed look at meaningful use from an experienced Eyecare auditor and certified coder.

  1. Is Meaningful Use Attestation the same as being compliant?
  2. Does using an EMR ensure your documentation will pass a coding audit?
  3. How do you know?

Have you ever asked the difficult questions?

I have–and the answers will surprise you.

Click on the Order Tab, order a block of four, or with our Site License option receive this Webinar, access to all recorded Webinars (over 40) plus new Webinars for a full twelve months.

Priority Question and Answer Service for coding, billing, and documentation questions

This support service will use a formal Ticket System plus include a  searchable Knowledge-Base (KB), organized by category with hundreds of the most common Eyecare coding and billing questions. The goal is to answer all posted questions within 24 hours. The KB will be available 24X7. Most questions should be answered the same day, during normal business hours (M-F, 8-5).

Until the end of October, you can test out the system below. You can view over 75 of the most common questions in the knowledge-base without creating a user ID.

http://eyecodingforum.com/codingsupport/

After Nov 1 if you wish to test the system send us an email on our contact form and we will set you up with a temporary ID. You have a coding question, post it and then you will be notified of a response within 24-48 hours.

This Priority Q and A service is available for only $25 per month or free toall EyeCodingForum:

  1. Site License clients ($499 per year)
  2. ICD-10 Comprehensive Coding Course clients ($275 until Oct 1 2016).

Remember just one paid claim or coding question solved could pay for the service for an entire year.

Thanks

Jeffrey Restuccio, CPC, COC, MBA
Coding Specialist in Eyecare

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.

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.