• Increase Your Coding and Reimbursement Expertise at AAO 2014

    Have you tested your coding knowledge lately? If not, this 20-question self-assessment can give you a quick benchmark. If you plan to attend AAO 2014 in Chicago, your quiz results can help you plan what coding courses to take.

    1. Can you bill Eye codes more than once a year? The answer depends upon the payer. Medicare Part B does not have frequency edits on Eye codes, but most commercial payers will only cover a comprehensive exam once a year.
    2. How many elements constitute a comprehensive E&M or Eye code? Twelve elements of the exam. For E&M to be comprehensive, you must document a mental assessment as well.
    3. Which exam codes include dilation? Unless contraindicated, new patient exams 99204, 99205, 92004 and established patient exams 99215.
    4. Is there a correct order to the CPT codes when billing testing services on the Multiple Procedure Payment Reduction indicator list? No. The payer makes the adjustment automatically. 
    5. All testing services require interpretation and report. What should that documentation state? There are no specific guidelines.
    6. What is the correct way to bill and confirm proper payment for biometry services for Medicare Part B and commercial payers? Each payer has their own requirements. Medicare Part B is unique in that there is one payment for measuring each eye and a payment for the interpretation of each individual eye.
    7. Which modifiers are appropriate to use when billing diagnostic testing services? When the practice owns the equipment and performs the test, no modifier is necessary.
    8. What is the appropriate procedure when billing for emerging technology? Category III codes typically are not assigned an allowable for the payer. Therefore the patient is responsible for payment. For Medicare Part B patients, you should obtain an advance beneficiary notice.
    9. What documentation is required when you delegate a testing service? Any test that is not performed by the physician must include an order indicating which tests and which eyes. The chart note should also document the medical necessity.
    10. Which modifiers are under federal and commercial payer scrutiny? All of them! Currently modifiers –24, –25 and –59 receive the most scrutiny.
    11. Are postoperative complications payable when you perform additional surgery in the office setting? Yes.
    12. Is there a national visual acuity requirement for cataract surgery? No. Each payer has its own requirements.
    13. What constitutes complex cataract surgery according to payer rules? The CPT description details the indications. Do not use it for complications that occur during surgery.
    14. What types of out-of-pocket fees can you charge patients when it comes to cataract surgery? Only fees associated with a premium IOL and limbal-relaxing incision surgery.
    15. What are the different types of federal and commercial payer audits? There are many, depending on the focus of the payer.
    16. What process should practices follow once they receive a request for records? Take the request seriously. Provide the documentation by the indicated due date. Dictate paper records that are difficult to read.
    17. Where can you find Medicare Administrative Contractor local coverage determinations, i.e., the guidelines that you’ll be subject to in an audit? www.aao.org/coding
    18. Are you confident in your application of modifier –25? This modifier designed for established patient exams indicates that it is separately identifiable from the minor surgical procedure performed the same day.
    19. What are your options in terms of avoiding penalties and achieving bonuses for the federal Physician Quality Reporting System, value-based modifier and electronic health record programs? Visit www.aao.org/pqrs
    20. Have you and your staff passed the Ophthalmic Coding Specialist exam? Learn more at www.aao.org/ocs.

    In addition to AAO 2014’s numerous coding courses, practice management experts will gather in the YO Lounge on Monday, Oct. 20, for a two-hour discussion on “Managing YO Practice.” Plan to join David Denniston, Donna Howell and Lawrence Geller, from 11:30 a.m. to 1:30 p.m. YO ribbon required to access the lounge.

    You can also bring your own questions to the American Academy of Ophthalmic Executives Practice Management and Coding Center at the Academy Resource Center Booth 508. Throughout AAO 2014, the booth will be staffed by experts who can assist you with all of your critical business needs. Schedule a free 20-minute consultation at AAOE’s Conversations With the Experts or stop by between sessions. The exhibit hall will be open 9 a.m. to 5 p.m. Saturday through Monday, Oct. 18 to 20, and 9 a.m. to 1 p.m. on Tuesday, Oct. 21.