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    Code-a-Palooza! Part 1: Could You Win Coding’s Annual Game Show?

    By Sue Vicchrilli, COT, OCS, Director of Coding and Reimbursement, and Jenny Edgar, CPC, CPCO, OCS, Academy Coding Specialist
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    What’s your favorite event at the annual meeting? For the past 5 years, one of my personal highlights has been Code-a-Palooza, an event like a game show. There are 2 teams that compete against one another and against the audience, which is supplied with a multiple-choice response system. This month and next, you can tackle some questions from the 2017 Code-a-Palooza.

    Finger on the Buzzer!

    Q1—when direct supervision is not needed. For Medicare Part B, which test does not require direct supervision (which is when a physician of the prac­tice must be present on site)?

    1. 76512 Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed nonquantitative A-scan)
    2. 95930 Visual evoked potential (VEP) testing central nervous system, checkerboard, or flash
    3. 92060 Sensorimotor examination with multiple measurements of ocular deviation (e.g., restrictive or paretic mus­cle with diplopia) with interpretation and report (separate procedure)
    4. 92235 Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral

    Q2—physician’s John Hancock. Which statement is false with regard to a physician signature?

    1. For paper charts, the signature log should be readily available.
    2. If you have an electronic health record (EHR) system, the protocol for the EHR signature should be readily available.
    3. Stamped signatures or physician signature/staff initials are still allowed if you have physician approval.
    4. If the physician signature is missing, the physician may make an attestation statement.
    5. If the physician signature is illegi­ble, the payer can automatically request a recoupment without even auditing the documentation.

    Q3—coding for butterfingers. Oops! As you were getting ready to inject a drug, you dropped the vial. Which of these statements is true?

    1. Bill for the drug using a HCPCS code with modifier –52 Reduced ser­vices. When you fill out the CMS 1500 form, include the reason for reduced services in box 19, which is the box that is designated for “additional claim information.”
    2. Bill for the drug using a HCPCS code with modifier –59 Distinct proce­dural service. Include the reason in box 19 of the CMS 1500 form.
    3. The lost drug is not reimbursable by the payer or patient. Contact the company rep to see if free drug can be provided.
    4. Bill for the drug and double the units. Include the reason in box 19 of the CMS 1500 form.

    Answers

    1—when direct supervision is not need­ed. Answer: C is true. The sensori–motor exam has general supervision for Medicare Part B.

    More to the story. Ophthalmic tests requiring direct supervision include:

    • 76510 Diagnostic A- and B-scan
    • 76511 Quantitative A-scan
    • 76512 B-scan
    • 76513 Anterior segment ultrasound
    • 92235 Fluorescein angiography (FA)
    • 92240 Indocyanine green angiography (ICGA)
    • 92242 FA and ICGA
    • 95930 VEP

    For commercial payers who do not follow CMS rules, all tests require direct supervision.

    2—physician’s John Hancock. Answer: C is false. Stamped signatures or physician signature/staff initials are still allowed, provided that you have physician approval.

    More to the story. According to CMS ICN 905634, stamped signatures are only permitted in the case of an author with a physical disability who can provide proof to a CMS contrac­tor of inability to sign because of a disability.1

    3—coding for butterfingers. Answer: C is true. The lost drug is not reimburs­able by the payer or patient. Contact the company rep to see if free drug can be provided.

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    1 www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Signature_Requirements_Fact_Sheet_ICN905364.pdf. Accessed Dec. 15, 2017.

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    The Academy is the recognized authority in ophthalmic coding. To help you appropriately maximize reimbursement, Academy experts have developed a valuable library of coding products.

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