Series 5 coding Power Point 92010 - Idaho Optometric Physicians
Series 5 coding Power Point 92010 - Idaho Optometric Physicians Series 5 coding Power Point 92010 - Idaho Optometric Physicians
10/29/2010Required Elements for IntermediateOphthalmological Service5. External ocular/adnexal examination6. Other diagnostic procedures as indicated7. Initiation (or continuation) of a diagnostic and treatmentprogramKey: If one (or more) of these elements is missing,the visit cannot be coded as intermediateophthalmological service.CPT Definition for ComprehensiveOphthalmological Service• “Comprehensive ophthalmological services describes ageneral evaluation of the complete visual system. Thecomprehensive services constitute a single service entitybut need not be performed at one session. The serviceincludes history, general medical observation, externaland ophthalmoscopic examinations, gross visual fields andbasic sensorimotor examination. It often includes, asindicated: biomicroscopy, examination with cycloplegia ormydriasis and tonometry. It always includes initiation ofdiagnostic and treatment programs.”• New (92004) or established (92014) patientRequirements of ComprehensiveOphthalmological ServiceAgain, payers often develop their own interpretationsof these definitions, but the elements that arerequired by the CPT definition are:1. General evaluation of the complete visual system2. History3. General medical observation4. External examinationRequirements of ComprehensiveOphthalmological Service5. Ophthalmoscopic examination (with or withoutcycloplegia or mydriasis6. Gross visual fields7. Basic sensorimotor examination8. Initiation of diagnostic and treatment programIf one (or more) of these elements is missing, thevisit cannot be coded as comprehensiveophthalmological service.Initiation of Dx/TxProgram Is Critical• Most frequent target of reviewers/ auditorsof eye care records• Every office must have a clear definitionand understanding of what’s included ineach component of the CPT definition,especially the initiation (continuation) ofdiagnostic and treatment programYour Initiation of Initiation of Dx/TxProgram• Probably will include 15‐20 items, ie:– Return to Office• For recheck• For additional tests– Rx meds– Rx specs– Rx CLs– Refer for Dx/Tx8
10/29/2010Know the Definitions and Comply• All eye care offices report many visits using 92000codes• Many offices are unfamiliar with the CPT definitionsand requirements for those codes• Those offices are very vulnerable to audits byinsurers• Must not use any codes unless familiar with the CPTdefinitions/requirementsCoding Our Visits with 92000 CodesIntermediate Ophthalmological Service (92002/92012)__ 1. A new or existing condition…__ 2. complicated with a new diagnostic or managementproblem not necessarily relating to the primary diagnosis__ 3. History__ 4. General medical observation__ 5. External ocular/adnexal examination__ 6. Other diagnostic procedures as indicated__ 7. Initiation (or continuation) of a diagnostic and treatmentprogramRequirements for 92004/92014Comprehensive Ophthalmological ServiceA general evaluation of the complete visual system…__ 1. History__ 2. General medical observation__ 3. External examination__ 4. Ophthalmoscopic examination (with or without cycloplegiaor mydriasis__ 5. Gross visual fields__ 6. Basic sensorimotor examination__ 7. Initiation of diagnostic and treatment programSurprisingly, each of these visits could have been billed as 92014Both Examples Qualify as 92014• Each of our cases qualified as some level of99000 and alternatively as 92014• More specific requirements might favorchoosing the 99000 codes in some cases• Less stringent, more general requirements,might favor choosing the 92000 codes in othercases• Knowing the rules lets you chooseintentionally and accurately!Projects for Doctors and Staff• Pull ten charts and their route slips or claim forms• Print out PMI grading sheets for the 99000 and the 92000codes codes (available at http://www.aoa.org/x16167.xml)• Utilize grading sheets to– Choose level of 99000 code for each– Use 92000 grading sheets to choose 92000 codes• Consider advantages/disadvantages of each code for eachcase• Decide whether 99000 or 92000 fits each visit bestMore Webinars to Come• Additional webinars in this series will be basedon…– Your requests for specific subjects to cover– Most frequently asked questions received andanswered at askthecodingexperts@aoa.org– New issues that arise to challenge AOA membersrelative to medical records, coding, etc.– Your feedback/suggestions are critical9
- Page 1: 10/29/2010Presented byCharles B. Br
- Page 4 and 5: 10/29/2010Grading Past/Family/Socia
- Page 6 and 7: 10/29/2010Physical Examination, Par
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10/29/2010Required Elements for IntermediateOphthalmological Service5. External ocular/adnexal examination6. Other diagnostic procedures as indicated7. Initiation (or continuation) of a diagnostic and treatmentprogramKey: If one (or more) of these elements is missing,the visit cannot be coded as intermediateophthalmological service.CPT Definition for ComprehensiveOphthalmological Service• “Comprehensive ophthalmological services describes ageneral evaluation of the complete visual system. Thecomprehensive services constitute a single service entitybut need not be performed at one session. The serviceincludes history, general medical observation, externaland ophthalmoscopic examinations, gross visual fields andbasic sensorimotor examination. It often includes, asindicated: biomicroscopy, examination with cycloplegia ormydriasis and tonometry. It always includes initiation ofdiagnostic and treatment programs.”• New (92004) or established (92014) patientRequirements of ComprehensiveOphthalmological ServiceAgain, payers often develop their own interpretationsof these definitions, but the elements that arerequired by the CPT definition are:1. General evaluation of the complete visual system2. History3. General medical observation4. External examinationRequirements of ComprehensiveOphthalmological Service5. Ophthalmoscopic examination (with or withoutcycloplegia or mydriasis6. Gross visual fields7. Basic sensorimotor examination8. Initiation of diagnostic and treatment programIf one (or more) of these elements is missing, thevisit cannot be coded as comprehensiveophthalmological service.Initiation of Dx/TxProgram Is Critical• Most frequent target of reviewers/ auditorsof eye care records• Every office must have a clear definitionand understanding of what’s included ineach component of the CPT definition,especially the initiation (continuation) ofdiagnostic and treatment programYour Initiation of Initiation of Dx/TxProgram• Probably will include 15‐20 items, ie:– Return to Office• For recheck• For additional tests– Rx meds– Rx specs– Rx CLs– Refer for Dx/Tx8
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