Medicare administrative contractor Palmetto has recently sent comparative billing reports to practices in North Carolina, South Carolina, Virginia and West Virginia. If you received a letter indicating you are an outlier in certain areas, Palmetto wants you to submit additional information.

Palmetto is looking at:

• E&M or Eye visit code exams; and
• Cataract or complex cataract surgery.

If you are an outlier, you need to send Palmetto responses to the following five questions:

1. Is there documentation present for all dates of service billed and/or operative eye billed?
2. Is patient’s own assessment of functional status causing him/her to seek medical attention?
3. Is there evidence of a comprehensive eye examination and ocular examination and a single diagnostic A-scan to determine the appropriate lens?
4. Is there documentation indicating that the cataract is significantly contributing to the patient’s visual impairment in the presence of one or more concomitant ocular diseases?
5. What are your self-auditing methods?

Ophthalmology practices face audits more frequently than ever. Your best defense against audit triggers and costly penalties remains the Academy’s advanced coding resources. These include:

• Palmetto local coverage determinations
• How to use the VF-8R form
• How to document the need for cataract surgery
• 1-Hour Coding Course: Eye Visit Code Documentation Guidelines
• 1-Hour Coding Course: Complete Guide to Documenting and Coding Cataract Surgery
• 1-Hour Coding Course: E/M Documentation Guidelines for All Specialties
• E&M Internal Chart Auditor for Ophthalmology, 2nd Edition, Online
• Ophthalmic Coding: Learn to Code the Essentials