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April 2007

Savvy Coder: Coding & Reimbursement
Are You an Ophthalmic Coding Specialist? If Not, Why Not?
By Sue Vicchrilli, COT, OCS, Academy Coding Executive, and
Michelle Kimbrough, JCAHPO Director of Programs and Services

Over the years, we noted that physicians commonly asked, “How can I tell whether my staff can code properly?” In response to such queries, the Academy, the AAOE and the Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO) joined together to establish an ophthalmic coding competency exam. The three associations asked Michael L. Gilbert, MD, OCS, to chair a task force that included four physicians, two technicians, two administrators and two coders. And in 2004, the Ophthalmic Coding Specialist exam was launched.

Exam design. Following three rounds of pilot testing with 30 participants, the Ophthalmic Coding Specialist exam was refined to 105 multiple choice questions.

To truly test total competency, questions are taken from 18 content areas: CPT, ICD-9, Evaluation & Management, Eye Codes, Modifiers, Special Testing Services, Minor Surgery, Major Surgery, Compliance, Anterior Segment, Cornea, Glaucoma, Dispensing, Neuro-Ophthalmology, Oculoplastics, Pediatric and Strabismus, Retina and Vision Rehabilitation.

And just like coding in the real world, the test is open-book.

OCS distinction. Those who score at least 80 percent on the exam receive the distinction of Ophthalmic Coding Specialist and may use the OCS initials following their name. Because the rules and regulations of reimbursement are constantly changing, OCS participants are required to retest every three years. No continuing education units (CEUs) are required.

How to prepare. In addition to their working knowledge, participants can prepare for the exam by attending CODEquest coding courses and Coding Camp, reviewing the content in the Ophthalmic Coding Series, referencing the Ophthalmic Coding Coach and using resources like CPT, ICD-9, HCPCS and CMS Web sites.

How to sign up. Log on to and download the application form. Exams will be mailed after JCAHPO receives your application. You have 10 working days to complete the open-book exam in the privacy of your home or office. The test is estimated to take approximately eight hours to complete. Then mail all materials back to JCAHPO for scoring. JCAHPO will mail your results and feedback report within four weeks of submission. The feedback report helps you to pinpoint any areas that you may need to read up on.

Who’s an OCS? As of January 2007, 1,073 physicians, coders/billers, ophthalmic medical personnel, office managers and administrators had taken the exam. A list of all those who have successfully passed the exam can be found online: Go to and select “Coding & Reimbursement.”


Test Yourself Online

Want to test your coding knowledge? Go online for 12 questions that are typical of the OCS exam. These include:

  • Which modifier tells the Medicare intermediary that you have obtained an Advance Beneficiary Notice (ABN) from the patient: A) –GY, B) –GW or C) –GA?
  • When you remove multiple corneal foreign bodies from both eyes, payment is: A) per eye, B) per session or C) per foreign body?
  • If you see the same patient the next day for follow-up, the office visit is: A) billable with the appropriate level of E&M or Eye Code or B) not billable as the visit is part of the global period?

Download the sample test. Visit select “Coding and Reimbursement” and then “Test Your Coding Competence.” (You must log in to access this.)