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Welcome to CODE quest 2008!

Welcome to CODE quest 2008!. Congratulations to all who have passed the Ophthalmic Coding Specialist Exam. Ms. Vicchrilli does not have any financial interest or relationships to disclose. CODEquest – Financial Disclosure. In the following patient examples, we will cover:

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Welcome to CODE quest 2008!

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  1. Welcome to CODEquest 2008!

  2. Congratulations to all who have passed the Ophthalmic Coding Specialist Exam

  3. Ms. Vicchrilli does not have any financial interest or relationships to disclose. CODEquest – Financial Disclosure

  4. In the following patient examples, we will cover: E&M vs. Eye codes Consultations Special testing CODEquest Topics

  5. Modifier application Minor procedures for each specialty Major surgical procedures for each specialty; and CODEquest Topics

  6. Answer the really tough questions. CODEquest Topics

  7. Billing for the interim exam between cataract surgeries Billing for an injection and an exam the same day Billing for OCT and fundus photography on the same day CODEquest Topics

  8. Coding for new corneal procedures CODEquest Topics

  9. There will also be staff meetings. Agenda What’s new in 2008 Ethics EOMB errors CODEquest Topics

  10. Tips from the most effective offices. CODEquest Topics

  11. Medicare Part B deductible increases to $135 compared to $131 in 2007. What’s New in 2008

  12. 2008 CPT Update Initial Nursing Facility Care Change of description 99304 Physicians typically spend 25 minutes with the patient and/or family or caregiver 99305 35 minutes 99306 45 minutes

  13. 2008 CPT Update Subsequent Nursing Facility Care Change of description 99307 Physicians typically spend 10 minutes with the patient and/or family or caregiver. 99308 15 minutes 99309 25 minutes 99310 35 minutes

  14. 2008 CPT Update • CPT code 67038 Vitrectomy, mechanical, pars plana approach; with epiretinal membrane stripping – will be deleted and replaced with three new codes

  15. 2008 CPT Update • 67041   Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane (eg, macular pucker)

  16. 67041 CCI edits: 36000, 36410, 37202, 62318, 62319, 64415, 64416, 64417, 64450, 64470, 64475, 65800, 65805, 65810, 65815, 66830, 66840, 66852, 66920, 66930, 66940, 67005, 67010, 67015, 67025, 67027, 67028, 67036, 67101, 67105. 67107, 67110, 67112, 67120, 67121, 67141, 67145, 67500, 67515, 68200, 90760, 90765, 90772, 90774, 90775. Mutually exclusive 69990

  17. 67041 RVUs: 30.23 no site-of-service differential Global period: 90 days Assistant-at-surgery: yes  

  18. 2008 CPT Update • 67042   with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil)

  19. 67042 CCI edits: 36000, 36410, 37202, 62318, 62319, 64415, 64416, 64417, 64450, 64470, 64475, 66830, 66840, 66852, 66920, 66930, 66940, 67025, 67036, 67108, 67110, 67112, 67500, 90760, 90765, 90772, 90774, 90775. Mutually Exclusive 69990

  20. 67042 RVUs: 34.62 no site-of-service differential Global period: 90 days Assistant-at-surgery: yes  

  21. 2008 CPT Update • 67043   with removal of subretinal membrane (eg, choroidal neovascularization), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil) and laser photocoagulation

  22. 67043 CCI edits: 36000, 36410, 37202, 62318, 62319, 64415, 64416, 64417, 64450, 64470, 64475, 66830, 66840, 66852, 66920, 66930, 66940, 67025, 67036, 67107, 67108, 67110, 67112, 67113, 67500, 90760, 90765, 90772, 90774, 90775. Mutually Exclusive 69990

  23. 67043 RVUs: 36.33 Global period: 90 days Assistant-at-surgery: yes  

  24. 2008 CPT Update • 67113 Repair complex retinal detachment (eg, proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 degrees), with vitrectomy and membrane peeling, may include air, gas, or silicone oil tamponade, cryotherapy, endolaser phtoocoagulation, drainage of subretinal fluid, scleral buckling, and/or removal of lens 

  25. 67113 CCI edits: G0186, 36000, 36410, 37202, 62318, 62319, 64400, 64402, 64405, 64415, 64416, 64417, 64450, 64470, 64475, 66830, 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984, 66985, 66986, 67005, 67010, 67015, 67025, 67028, 67030, 67031, 67036, 67039, 67040, 67041, 67042, 67101, 67105, 67107, 67108, 67110, 67112, 67141, 67145, 67208, 67210, 67218, 67220, 67221, 67227, 67228, 67500, 67515, 68200, 90760, 90765, 90772, 90774, 90775. Mutually Exclusive 69990

  26. 67113 RVUs: 39.88 Global period: 90 day Assistant-at-surgery: yes  

  27. 2008 CPT Update • 67229 Treatment of extensive or progressive retinopathy, one or more sessions; preterm infant (less than 37 weeks gestation at birth), performed from birth up to 1 year of age (eg, retinopathyof prematurity), photocoagulation or cryotherapy

  28. 67229 CCI edits: 36000, 36410, 37202, 62318, 62319, 64415, 64416, 64417, 64450, 64470, 64475, 67500, 67515, 90760, 90765, 90772, 90774, 90775. Mutually Exclusive 69990

  29. 67229 RVUs: 26.23 Global period: 90 day Assistant-at-surgery: no 

  30. CPT Update Change of description - ? 67227   Destruction of extensive or progressive retinopathy (eg, diabetic retinopathy), one or more sessions, cryotherapy, diathermy Old language 67227   Destruction of extensive or progressive retinopathy (eg, diabetic retinopathy), one or more sessions; cryotherapy, diathermy

  31. CPT Update Change of description 67228   Treatment of extensive or progressive retinopathy, one or more sessions; (eg, diabetic retinopathy), photocoagulation Old language Destruction of extensive or progressive retinopathy (eg, diabetic retinopathy), one or more sessions; photocoagulation (laser or xenon arc)

  32. CPT Update • 68816 Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilation

  33. 68816 CCI edits: 36000, 36410, 67202, 62318, 62319, 64415, 64416, 64417, 64450, 64470, 64475, 67500, 68810, 68811, 90760, 90765, 90772, 90774, 90775. Mutually Exclusive 69990

  34. 68816 RVUs: 15.91/5.67 Global period: 10 day Assistant-at-surgery: no  

  35. CPT Update Change of description 92135 Scanning computerized ophthalmic diagnostic imaging, posterior segment, (eg, scanning laser) with interpretation and report, unilateral

  36. CPT Update Category III code: 0187T Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral • No RVUs – until a local policy developed, patient is responsible for payment

  37. New PhotoScreening Code • 99174 Ocular photoscreening with interpretation and report, bilateral • (Do not report 99174 in conjunction with 92002-92014, 99172, 99173) • Deleted 0065T to create new Category 1 code for photoscreening • Not valued by the RUC

  38. HCPCS Update • Lucentis received a HCPCS code November 5th - • J2778, ranibizumab injection 0.1mg effective January 1, 2008.   Put 5 in the unit field

  39. ASC Update •  Effective January 1, 2008 all surgical procedures will be ASC approved, with the exception of - codes that contain the description of “with hospitalization” - procedures that require an over-night hospital stay 

  40. Office of the Inspector General • To promote integrity, economy, efficiency and effectiveness within all HHS programs • Chief audit and law enforcement executive for the entire Department, including the Centers for Medicare & Medicaid Services.

  41. 2008 OIG Work Plan • Place of Service Errors • Because different settings pay at different rates OIG wants to ensure accurate reporting of setting • E&M Services During Global Surgery Periods • Investigation as to the number of E&M services provided by physicians and reimbursed as part of the global surgery fee

  42. 2008 OIG Work Plan • Medicare Payments for Selected Physician Services • Very few details except that they will review appropriateness of billing for physician services • Medicare “incident-to” Services • Will review medical necessity, quality of care and documentation for these services

  43. 2008 OIG Work Plan • Assignment Rules by Medicare Providers • Providers can’t balance bill beneficiaries for amounts in excess of the Medicare allowable • Geographic Areas with High Utilization of Ultrasound Services • Examine disproportionately high Medicare allowed charges and services per beneficiary --codes affecting ophthalmology are: • 76510, 76511, 76512, 76513, 76514, 76516, 76519, 76529

  44. Questions?

  45. CIGNA LCDs

  46. CIGNA LCDs

  47. When you accept payment from a third party payer, each will have its own policies to follow: - Medicare - Non-Medicare or commercial payers - Medicaid

  48. - Review requirements for E&M - Review requirements for Eye codes E&M vs. Eye Codes

  49. E&M vs. Eye Codes

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