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  • An Ophthalmologist’s Quest for Coding Confidence

    I recently reviewed a list of AAOE® members who obtained their ophthalmic coding specialist (OCS) and ophthalmic coding specialist retina (OCSR) designations and found myself intrigued by the handful of ophthalmologists who have added these credentials to their already impressive achievements. I decided to reach out to one of these elite few to see what motivated their efforts and how it impacts patient care. 

    Anthony P. Johnson, MD, FACS, OSC, OCSR, of Tifton, Ga., agreed to share his coding journey with us. 

    Q: You have taken and passed both the OCS and OCSR competency tests, correct? 
    A: I took the OCS exam initially in 2016, then 2019, and just recently again in 2022. I just took the OCSR for the first time. 

    Q: What inspired you to seek both examinations? 
    A: Having the opportunity to work with the Academy’s coding and reimbursement team for the last several years opened my eyes to the need for each of us to have a better grasp of coding. I have embraced the balanced view that I don’t need to be a walking coding encyclopedia, but I need to know I can find the answer. The OCS and the OCSR prove that through the beauty of an open book test with 10 days to complete the 100-question exam. 
    Q: As a physician, how does understanding ophthalmic coding aid you in patient care? 
    A: Knowing the basics of coding is more than being certain the correct CPT code or diagnosis is chosen. Ultimately understanding payer policy is the basis for getting paid. Knowing the payer requirements for medical necessity, the covered diagnosis for exam codes or tests, whether pre-authorization is needed, as well as the global period for the procedure if applicable (they don’t always follow Medicare) … These make you the best advocate for the patient’s benefits and ensures timely delivery of their health care. Comprehending these details enables the physician to be a good coach for the techs and scribes. 

    Q: As a pediatric ophthalmologist, how does this level of coding expertise benefit your practice? 
    A: As a pediatric ophthalmologist, I don’t code for a lot of retina services. But I felt it was important to expand my knowledge with the OCSR and am glad I did it! For the pediatric ophthalmologist performing retinopathy of prematurity (ROP) care, this combination of general coding and retina coding expertise facilitates appropriate coding and documentation whether in the office or the neonatal intensive care unit (NICU).

    Obtaining the OCS/OCSR designations ensure you are familiar with the vital information for exams, ancillary testing and procedure coding, including the nuance of place of service and the required use of modifiers. Place of service creates a significant difference in coding and documentation requirements. It is also important to know the payer preferences for claim submission (example for bilateral procedure: one line with CPT code and -50 modifier or two lines and the -RT and -LT modifier).

    Overall correct coding ensures optimal payment to the practice with less chance of having to pay back due to over coding or inadequate documentation. It makes for fewer denials and reduced workload by staff having to repeat the process in corrections. 
    Q: Who would you recommend become competent in ophthalmic coding? 
    A: The entire team is essential, from the solo physician doing everything to the larger team with multiple techs, scribes and billing staff. Each member of the team is critical in identifying a modifier edit, recognizing the payer’s need for a unique code or catching the missing order or interpretation of a test. I find value in each member of the team being as coding proficient as possible, so why not demonstrate that proficiency by passing the OCS/OCSR exam? 
    Q: Why would you recommend other ophthalmologists become ophthalmic coding specialists? 
    A: Great question! Becoming an ophthalmic coding specialist offers you the best opportunity to know principles of coding, what the current issues are and where shortcomings are likely to occur. The OCS exercise also gives you confidence that you don’t have to have all details of coding memorized but reenforces that you know how and where to find the answers. Guessing can work but it can also lead to some bad habits, even false confidence you are coding correctly just because claims were paid. Paid claims can lead you to assume coding is correct. You could have a humbling surprise in the future with an audit and a recoupment! It happens! So, get your OCS or OCSR and be an asset to your practice. 

    Q: What would you say to those hesitant to take the test? 
    A: No one is particularly excited about any test, especially if it is “optional.” It is easy to say, “I will do it sometime” or “I already know I know this material, so I don’t need to be ‘showy’ by taking and passing a test.” I encourage you to reward yourself with taking the test.

    The process, with the right coding tools in hand (Coding Coach, Fundamentals of Ophthalmic Coding, Retina Coding: Complete Reference Guide and ICD-10 for Ophthalmology), gives you extra practice in using the resources. I suspect you will know the answer to half of the questions but looking up and confirming the answer assures success. I look forward to the next listing of those passing the OCS/OCSR and seeing your name! 
    Are you ready to take the Ophthalmic Coding Specialist exam? Dr. Johnson is rooting for you. 

    Further Resources 

    Ophthalmic Coding Specialist Exam