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  • Business and Management Annual Meeting Billing and Coding

    Try the Code-a-Palooza Quiz

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    At each annual meeting, the American Academy of Ophthalmic Executives® (AAOE®) offers an exciting and interactive course where two teams compete against each other and the audience on ophthalmic coding and reimbursement. 

    Five of the top questions are included below. Compare your answers with the audience and see if you should have been on the winning team!

    A. New Patient

    What is the correct level of a new patient exam when documentation supports a comprehensive history, detailed exam and moderate complexity decision-making?

    1. 99203
    2. 99204
    3. 99205

    B. Everyday Cataract Patient

    A new patient presents with complaints of: 

    • Decreased vision, OU and having trouble reading the newspaper each day.  
    • Glasses are not helping. 
    • Noticed for several months.  
    • Referring physician states bilateral nuclear sclerotic cataracts. 

    A complete Review of systems (ROS) and Past, family, social history (PFSH) is documented. The technician performs an IOLMaster on the patient to have ready for physician. 

    The physician then performs 12 exam elements plus mood and affect and determines cataract surgery is appropriate OD>OS. The patient meets with surgical coordinator to schedule.

    How should this be submitted?

    1. 99204 + 92136
    2. 99204 
    3. 99204+ 92136 -TC

    C. Apple of My Eye

    When is it appropriate to use an E/M audit tool for Eye visit codes?

    1. Never
    2. Always
    3. Only when determining medical decision making

    D. Locum What?

    A physician in a group practice is moving out of state. The administrator has contracted with another ophthalmologist who has her own practice, to come and fill in while they look for a new hire. Which of the following answers is true when billing locum tenens? 

    1. The locum tenens physician will bill under the practice NPI using modifier -Q5. 
    2. The locum tenens physician will bill under the practice NPI using modifier -Q6. 
    3. Since the original physician is leaving the practice, locum tenens cannot apply. 

    E. Referral

    A new patient to a practice is examined by the glaucoma specialist and referred on the same day to the retina specialist in the same group for an unrelated problem.  Each physician is using their unique subspecialty taxonomy code. Which of the following statements is true?

    1. Retina specialist submits appropriate level of established patient exam.
    2. Retina specialist submits the appropriate level of new patient exam.
    3. When two physicians of the same specialty see the same patient, the same day, only one can bill.  Therefore, no claim will be submitted by the retina specialist.

    About the author: Jenny Edgar, CPC, CPCO, OCS, OCSR, is a manager in the Academy’s Coding and Reimbursement office. She also is a contributing author to the Ophthalmic Coding Coach and Ophthalmic Coding series.

    How did you do?

    See the correct answers below.

    So, how did you do? Consider participating and take home bragging rights next year at AAO 2020 in Las Vegas!