Last year’s CODEFest at AAO 2014 in Chicago proved to be an exciting and essential course, with more than 250 attendees — including billers, administrators and physicians — joining the fun.
During the coding challenge, teams compete to correctly answer questions about everything from coding fundamentals to more advanced concepts, like exams, diagnostic testing and surgical cases.
Check out these CODEFest questions and see how your own coding competency compares! (Answers follow.)
1. A skilled nursing facility patient is seen in your office for both a retina optical coherency tomography and intravitreal injection. What should you bill to Medicare Part B?
A. 92134–26, 67028 and drug
B. 92134–26, 67028
2. You are the physician on call for your group, and you’ve opted out of Medicare Part B. Can Medicare patients who see you for an emergency file a Part B claim?
A. Yes
B. No
3. You examine a hospital inpatient in your office because the hospital doesn’t have an eye lane. How would you code?
A. Code place of service as hospital
B. Code place of service as office
C. No charge, as you’ll never get paid for these exams
4. You order a visual field test on a Medicare Advantage Plan patient with the diagnosis of headache. Is this a case when your staff should obtain an Advance Beneficiary Notice, since you don’t know whether a headache is a covered diagnosis?
A. Yes
B. No
5. Commercial insurance still recognizes consult codes. Medicare is the secondary payer. Is it appropriate to bill a consult on this patient?
A. Yes
B. No
Answers
1. B. 92134–26, 67028
- Medicare Part B will not pay for the drug while the patient is in a skilled nursing facility. You should contact the facility prior to injections to confirm they will reimburse for the cost of the drug. Have them send over the confirmation in writing. Also find out how long the patient will be receiving care to see if the injection can wait.
2. B. No
- When it comes to Medicare Part B patients, opt-out physicians should not be an option for the on-call list because they don’t bill the Medicare program. In rare circumstances, if the opt-out physician or practitioner provides emergency care in the hospital emergency room and the critical situation continues after admission to the intensive or critical care unit, he or she could continue to care for the patient until it is no longer urgent. Keep in mind that supplemental insurances typically won’t provide payment either, since there is no way for the primary Medicare Part B insurance claim to be filed.
3. A. Code POS as hospital
- This is true as long as the patient has the status of an inpatient. Remember that the hospital setting POS is 21.
4. B. No
- CMS explicitly states that the ABN is not a Medicare Advantage–approved document. Nor is an ABN appropriate for commercial plans. It’s best to check with each payer to see if you need preauthorization.
5. B. No
- CMS doesn’t recognize office-based consult codes (99241–99245). Because they won’t pay the 20 percent, you can’t bill the patient. It’s best to submit the appropriate level of E&M or Eye code. Be sure to continue communicating with the requesting source.
Save the date for next year’s CODEFest during AAO 2015 in Las Vegas. Visit the American Academy of Ophthalmic Executives’ website in the coming months for more information.
* * *
About the author: Sue Vicchrilli, COT, OCS, is the Academy’s director of coding and reimbursement and the author of EyeNet’s “Savvy Coder” column and AAOE’s Coding Bulletin, Ophthalmic Coding Coach and Ophthalmic Coding series. Jenny Edgar, CPC, CPCO, OCS, is the Academy’s coding specialist. She oversees the Academy’s Chart Auditing Service and is also a contributing author to the Ophthalmic Coding Coach and Ophthalmic Coding series.