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  • 5 Co-Management Coding Tips

    The third and final area of focus in the comparative billing report released by the Centers for Medicare & Medicaid Services (CMS) in September 2022 was co-management. The report specifically explored the percentage of cataract surgeries where a different provider rendered post-operative care. If you provide co-management care to patients, follow these five tips: 

    Tip #1. Review the Academy’s Comprehensive Guidelines for the Co-Management of Ophthalmic Postoperative Care
    This guide “clearly defines how the ophthalmologist as the surgeon can appropriately share pre- and postoperative responsibilities with non-surgeon providers, and how those providers may be ethically and legally reimbursed for their services.”  

    Tip #2. Determine If the Payer Allows for Co-Management
    Always ask who is the payer? Medicare allows for co-management for certain procedures, but other payers may not. 

    Tip #3. Obtain Informed Consent for Co-Managed Surgical Care
    A requirement for all payers that allow co-management is that the surgeon must keep a copy of the written co-managed surgical care agreement and transfer of delegated care in the patient’s medical record. For additional legal considerations and a sample consent for planned co-management after eye surgery form, visit Ophthalmic Mutual Insurance Company’s (OMIC) Co-management of surgical patients resource.

    Tip #4. Follow Payer’s Co-Management Coding Rules
    Medicare payers outline specific requirements for physicians who furnish part of a global surgical package CMS IOM Pub. 100-04, Claims Processing Manual, Chapter 12, section 40.2. These requirements include the use of specific modifiers: 
    • -54 Surgical care only
    • -55 Postoperative management only
    Find a comprehensive review of these and the top modifiers used in ophthalmology including case examples in the Academy’s 2023 Fundamentals of Ophthalmic Coding. Review Ask the Coding Experts to confirm appropriate coding when the surgeon provides a part of the global period. 

    Tip #5. Calculate the Appropriate Reimbursement
    The amount paid by Medicare Part B to the two physicians is never more than the total global surgical fee provided by only one physician. Here’s an example of how to calculate correct payment for Medicare payers: Post-Operative Co-Management - Modifiers 54 and 55 (