News from the AOA's Blog

Edited by Chuck Brownlow, O.D., Medical Records consultant

2012 is here and a new year always brings Medicare changes, new ICD-9 codes, and new procedure codes. Sometimes a new year also means the end for codes we’ve used for many years. Some of the insurance companies may not recognize and adopt the changes on Jan. 1, but all providers should be aware of and implement the changes as soon as they are in effect. Most of the changes were technically in effect on Oct. 1, and all should be implemented by now. Read the rest of this entry ?

Edited by Chuck Brownlow, O.D., Medical Records consultant

As usual, Current Procedural Terminology and International Classification of Diseases—9th Edition have introduced new codes. Some insurers began requiring the new codes be used as of Oct. 1, 2011; others will begin requiring them Jan. 1, 2012; and still others will straggle along and possibly not recognize any changes until late in the first quarter of 2012. It’s usually best to adopt the new codes as early as possible, Begin using them on your claims and continue to use them unless a specific insurer clarifies that they want you to continue to use the outdated codes. Read the rest of this entry ?

Edited by Chuck Brownlow, O.D., Medical Records consultant

You’ve got just over a month to get ready for a brand-new year in practice. It’s a pretty exciting time for most of us… “Out with the old, in with the new,” “ Turning over new leaves” and all that kind of stuff. If you are at all like me though, much of the old will still be around come next April, and a lot of old habits and issues will be still be cluttering up the office.

In spite of that forecast of likely reality, here are a few things for you to consider. Read the rest of this entry ?

Edited by Chuck Brownlow, O.D., Medical Records consultant

For my first 10 years in practice, I conducted all my patients’ fundus evaluations without the aid of mydriatics or cycloplegics. During that same period, I used instruments that didn’t require topical anesthetics for measuring intraocular pressures.

At that time, the vast majority of my colleagues and I were practicing at a distinct disadvantage to ophthalmologists, who of course had the diagnostic pharmaceuticals available to them every day. Read the rest of this entry ?

Glaucoma coding will be quite different when completing claims for Medicare patients starting Oct. 1 and for all other insurers beginning Jan. 1, 2012. 

The International Classification of Diseases, Ninth Revision (ICD-9) is the classification used to code and classify diseases.

For what is currently defined 365.0 in the ICD-9 codes, Borderline Glaucoma, new codes have been designated (365.01, 365.02, 365.05). Read the rest of this entry ?

ICD-10 is totally different than ICD-9 in several important ways.

ICD-10 to replace ICD-9 for reporting services rendered after Sept. 30, 2013

Edited by Chuck Brownlow, O.D., Medical Records consultant

There is already much information available for the guaranteed arrival of the new diagnosis coding system, ICD-10.  Effective Oct. 1, 2013, just over two years from now, all diagnosis reporting on all claims for Medicare and all other insurers in the United States will be based upon ICD-10.  Read the rest of this entry ?

Edited by Chuck Brownlow, O.D., Medical Records consultant

Question: I’m currently being audited by a very large national insurance company. They say my records do not support the codes that I’ve reported. What can I do?

Answer: I don’t mean to be blunt, but if the insurer’s auditor is correct and your records don’t support the codes you’ve billed, chances are you will be paying money back to the insurer. This is becoming more common in health care, partially because all health care providers are much more interested in providing care than in learning the rules for billing for that care. Most providers have done an excellent job in providing patient care and in keeping up to date with changes in diagnosis and management of patients’ conditions. Unfortunately, many have not done a very good job of learning the rules for reporting that care to insurers, including the accurate choice of codes for their services. Read the rest of this entry ?

Edited by Chuck Brownlow, O.D., Medical Records consultant

Question: What’s this about a $505 fee that we have to pay in order to continue to supply post-op glasses to our cataract patients? 

Answer: Several months ago, the Centers for Medicare & Medicaid Services (CMS) announced that all Medicare providers and suppliers would have to pay a fee when they enroll or re-enroll. The AOA helped obtain an exemption from Congress for physicians, but the CMS decided not to extend the exemption to physicians who enroll as suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). All DMEPOS suppliers are required to re-enroll periodically and to pay a re-enrollment fee, currently $505, when their re-enrollment date comes around. No action is necessary until practitioners are informed by the National Supplier Clearinghouse that it’s time for them to re-enroll. They can continue to provide post-op glasses for cataract patients in the meantime. Our best information suggests that re-enrollment will be required every three years.  Read the rest of this entry ?

Edited by Chuck Brownlow, O.D., Medical Records consultant

The debate rages on with respect to which set of office visit codes is better for eye care: the 99000 series Evaluation & Management Services or the 92000 General Ophthalmological Services.  All office visit codes are listed in and defined by the American Medical Association (AMA) publication Current Procedural Terminology© (CPT), the only national authority regarding procedure codes and their definitions.  Read the rest of this entry ?

Edited by Chuck Brownlow, O.D., Medical Records consultant

The first four months of 2011 have provided challenges for all doctors who commonly provide retinal imaging services for their patients.

Some insurers and several Medicare carriers have published their guidelines for coverage of the new codes; 92132, 92133, and 92134; though many insurers have not.

As I’m writing this, the Centers for Medicare & Medicaid Services (CMS) have not released a National Coverage Determination (NCD) for the codes. Read the rest of this entry ?