With its game show–style format and lively musical soundtrack, Code-a-Palooza is a highlight of the annual meeting. Volunteers, drawn from the ranks of attendees, form two teams that compete against each other and against the crowd, which is encouraged to text answers via mobile phone. All this makes the quiz a fun way to identify gaps in your coding knowledge. The event—which is organized by the American Academy of Ophthalmic Executives (AAOE)—takes place each year at the Academy’s annual meeting
Five Tough Questions From Code-a-Palooza 2019
Test your knowledge. The five coding questions below got the most incorrect answers at last year’s contest.
First, try to recreate the Code-a-Palooza ambience. For the right vibe, line up a playlist that features songs by The Police (for Q1), The Modulations (Q2), Sammy Hagar (Q3), Van Halen (Q4), and U2 (Q5).
Q1—“I’ll Be Watching You.” Which of the following tests do not require direct supervision?
- B-scan (76512)
- Visual evoked potential (95930)
- Sensorimotor exam (92060)
- Fluorescein angiography (92235)
Q2—“Worth Your Weight in Gold.” The surgeon removes a gold weight from a patient’s right eyelid. What is the appropriate CPT code?
- 67912–RT Correction of lagophthalmos, with implantation of upper eyelid lid load (gold weight)
- Not coded separately. It is included in the postoperative period of 67912 or, if outside that post-op period, it is included in the exam.
- 67938–RT Removal of foreign body, eyelid
Q3—“I Can’t Drive 55.” An established patient needs to renew his driver license, and the Department of Motor Vehicles (DMV) requires a visual field. Is the practice entitled to payment for this service—and if so, who pays?
- The visual field is performed and billed to the payer using ICD-10 code Z04.8 Encounter for examination and observation for other specified reasons.
- Because it is required by the DMV, the practice must absorb the cost.
- If he is a Medicare patient, have him sign an Advance Beneficiary Notice of Noncoverage (ABN) prior to performing the visual field.
- The patient is responsible for payment.
Q4—“Somebody Get Me a Doctor.” If your practice is in a Health Professional Shortage Area (HPSA), when are you required to use modifier –AQ?
- Never. This modifier is no longer recognized.
- Never. Bonus payments are made automatically.
- Every time you submit a claim.
- Whenever the zip code area falls partially within a non–full county HPSA.
Q5—“I Still Haven’t Found What I’m Looking For.” If you don’t have an ophthalmology-specific list of ICD-10 codes (see aao.org/codingproducts), you can waste a lot of time looking for the right diagnosis code. What ICD-10 code(s) ought to be used for bilateral upper and lower lid ulcerative blepharitis?
- H01.01A + H01.01B
- H01.011 + H01.012
How Did You Do? Code-a-Palooza Answers
Here are the correct answers, plus the most common incorrect answers from Code-a-Palooza 2019.
1: C—Sensorimotor exam (92060). The other three tests require direct supervision. Remember “GDP” for the levels of supervision:
- General supervision does not require the physician to be in the suite while testing takes place.
- Direct supervision requires that a physician be in the suite and readily available if assistance is required while staff administer the test. The physician does not physically need to be present in the room while the test is performed.
- Personal supervision requires that the physician be in the room during testing.
Tests that do not designate a level of supervision must typically be performed by the physician. Keep in mind that commercial payers only recognize direct supervision rules.
Most common mistake: 40% of the audience gave the incorrect answer of: A—B-scan (76512).
2: B—Not coded separately. It is included in the postoperative period of 67912 or, if outside that post-op period, it is included in the exam. There is no code for removal of eyelid weights or punctal plugs. During the postoperative period, there would be no charge. If they were removed outside of the global period, submit the appropriate level of office visit.
Most common mistake: 50% of the audience gave the incorrect answer of: C—67938-RT Removal of foreign body, eyelid.
3: D—The patient is responsible for payment. “Required tests” are not always covered by payers. Check with individual payers as appropriate.
Most common mistake: 46% of the audience gave the wrong answer of: A—Visual field is performed and billed to the payer using ICD-10 code Z04.8 Encounter for examination and observation for other specified reasons.
4: D—Whenever the zip code area falls partially within a non–full county HPSA. Perform due diligence in verifying whether your location qualifies for the HPSA incentive. Medicare considers inappropriate usage as fraudulent. Monies will be recouped, and practices may be turned over to the Benefit Integrity contractors.
Modifier –AQ is required in the following circumstances:
- When zip code areas do not fall entirely within a designated full county HPSA bonus area.
- When a zip code area falls partially within a full county HPSA but is not considered to be in that county based on the USPS dominance decision.
- When a zip code area falls partially within a non–full county HPSA.
- When a zip code area was not included in the automated file of HPSA areas based on the date of the data used to create the file.
Most common mistake: 38% of the audience gave the wrong answer of: B—Never. Bonus payments are made automatically.
5: B—H01.01A Ulcerative blepharitis right eye, upper and lower eyelids + H01.01B Ulcerative blepharitis left eye, upper and lower eyelids. When added as a sixth character to H01.01 (the ICD-10 code for ulcerative blepharitis), A, B, and C represent the following:
A: right eye, upper and lower eyelids
B: left eye, upper and lower eyelids
C: bilateral, upper and lower eyelids
Note: All three characters (A, B, and C) can be applied in the same way to codes H02.20 (unspecified lagophthalmos), H02.21 (cicatricial lagophthalmos), H02.22 (mechanical), and H02.22 (paralytic lagophthalmos).
However, only A and B apply to H01.00 (unspecified blepharitis), H01.01 (ulcerative blepharitis), and H01.02 (squamous blepharitis)—ICD-10 keeps us on our toes!
Most common mistake: 50% of the audience gave the incorrect answer of: C—H01.011 + H01.012.
Don’t miss Code-a-Palooza! Be sure to attend the AAOE program (Nov. 13-17) in Las Vegas at AAO 2020 (Nov. 14-17) and see how you do at Code-A-Palooza 2020. This year, registration and hotel reservations for AAO 2020 (aao.org/2020) will open for Academy and AAOE members on April 8. To attend Code-a-Palooza, you will need to buy an Academy Plus course pass.
Mr. Baugh is program manager of Revenue Cycle Integrity and Quality Improvement Programs at the John A. Moran Eye Center in Salt Lake City; Ms. Edgar is Academy Coding Specialist; Ms. Vicchrilli is Academy director of Coding and Reimbursement.
Schedule a 2020 Chart Audit Today
A comprehensive chart audit is your first line of defense for avoiding claim denials and safeguarding reimbursements. The Ophthalmic Advisors Group offers consultation services from trusted Academy experts for chart audits, coding, business management, and more. Hourly or on-site daily appointments are available. Get started at aao.org/consulting.