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Technician’s Role in Medicare Compliance. Jill J Luebbert , CPOT, ABOC. Eye care can be more than vision care. Medical Codes vs Refractive Codes. 99000’s 92000’s. Technician’s play a key role. How you document determines the billing level. Let’s see what your role is.

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Presentation Transcript
eye care can be more than vision care
Eye care can be more than vision care

Luebbert Consulting & Training

medical codes vs refractive codes
Medical Codes vs Refractive Codes
  • 99000’s
  • 92000’s

Luebbert Consulting & Training

technician s play a key role
Technician’s play a key role
  • How you document determines the billing level

Luebbert Consulting & Training

let s see what your role is
Let’s see what your role is

Luebbert Consulting & Training

documentation is the key
Documentation is the key

Luebbert Consulting & Training

slide7

Pretest

  • Chairside documentation

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if it isn t written down
If it isn’t written down
  • It never happened

Xxxxxxxx

Xxxxxxxxxxx

xxxxxxxxxxxx

Luebbert Consulting & Training

parts of the examination
Parts of the examination
  • S
  • O
  • A
  • P

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update from soap
Update from SOAP
  • S = Subjective Data
  • NOW PFSH and ROS
  • O = Objective
  • NOW Physical Examination
  • A = Assessment
  • Remains Assessment
  • P = Plan
  • NOW Medical Decision Making & Management

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where do we start
Where do we start?

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we start at the beginning
We start at the beginning
  • Subjective Data
  • HPI
    • History of Present Illness
  • PFSH
    • Past, Family, and Social History

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chief complaint
Chief Complaint
  • ‘What brings you here today?’

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why is this important
Why is this important?
  • Determines what happens next
  • Is the chief complaint medically oriented?

Refractive - 92000

Medical - 99000

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examples of medically oriented
Examples of ‘medically oriented’
  • Vision cloudy
  • Feel itchy
  • Teary
  • Vision fluctuates
  • Shadows
  • Headaches
  • Red

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medically oriented
Medically oriented…..
  • NOW………….
  • 99000 CODES

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if you ask or observe
If you ask or observe
  • DOCUMENT!!!!!!!!!

Luebbert Consulting & Training

history of present illness hpi
History of Present Illness (HPI)
  • Location (where)
  • Quality (sharp, dull, hazy)
  • Severity (mild, severe, bothersome)
  • Duration (constant, off & on)
  • Timing ( mornings, mid-day)
  • Context (driving, reading)
  • Modifying Factors (bright light, close eyes)
  • Associated Signs & Symptoms(itch, headache)

Luebbert Consulting & Training

hpi catagories
HPI catagories
  • If you investigate and document 1 – 3 items
    • Brief
  • If you investigate and document 4+ items
    • Extended

Location (where)

Quality (sharp, dull, hazy)

Severity (mild, severe, bothersome)

Duration

Timing

Context

Modifying Factors

Associated Signs & Symptoms

Luebbert Consulting & Training

review of systems ros
Review of Systems (ROS)
  • Allergies (environmental, drug)
  • Cardiovascular (hypertension, stroke)
  • Constitutional ( weight loss, fevers)
  • Ears, Nose, Mouth, Throat (upper respiratory)
  • Endocrine (NID, ID, thyroid, hormonal)
  • Eyes (GLC, AMD, Surgery)
  • Gastrointestinal (ulcers, colitis)
  • Genitourinary (STD)

Luebbert Consulting & Training

slide21
ROS
  • Hematologic/Lymphatic (anemia, leukemia)
  • Integumentary (psoriasis, eczema, rosacea)
  • Musculo-skeletal(osteoarthritis, fibromyalgia)
  • Neurological (MS, epilepsy)
  • Psychiatric (depression, panic disorders)
  • Respiratory (cigarette smoker, asthma)

Luebbert Consulting & Training

slide22
ROS
  • If you investigate and document 1 area
    • Problem Pertinent
  • If you investigate and document 2 – 9 areas
    • Extended
  • If you investigate and document
    • Complete (Can say all others are negative)

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past family and social history pfsh
Past, Family, and Social History(PFSH)
  • Past
    • Ocular – cataract, AMD, GLC, surgery
    • Medical – diabetes, hypertension
  • Family History
    • Ocular – cataract, AMD, GLC, surgery
    • Medical – diabetes, hypertension
  • Medication
    • OTC and pharmaceutical
  • Social
    • Smoking, alcohol, hobbies

Luebbert Consulting & Training

slide24
PFSH
  • If you investigate and document 1 area
    • Pertinent
  • If you investigate and document 2 – 3 areas
    • Complete
    • Required
      • if new patient

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at this point
At this point,
  • Billing level groundwork is laid

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will this visit be
Will this visit be….
  • Problem Focused
  • Extended Problem Focused
  • Detailed
  • Comprehensive

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physical examination
Physical Examination
  • If you looked at it
  • DOCUMENT IT!!!!!
  • If the doctor looks at it
  • DOCUMENT IT!!!!!

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if you are chairside assisting
If you are chairside assisting
  • Be observant
  • The doctor may not follow the ‘traditional’ sequence
  • Document

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eye elements
Eye Elements
  • Acuity
  • Visual Fields (confrontation)
  • Tonometry
  • Ocular Motility (cover tests, EOM)

Luebbert Consulting & Training

eye elements1
Eye Elements
  • Adnexae (lids, lashes, puncta, orbit)
  • Conjunctiva (palpebral, bulbar)
  • Anterior Chamber
  • Pupil / Iris
  • Cornea
  • Anterior Chamber
  • Crystalline lens
  • Retina (macula, foveal reflex, a/v ratio)
  • Cup/Disc

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systemic element
Systemic Element
  • Orientation to time, place, person
  • General Constitution (mood)

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at this point1
At this point……
  • Determine if additional groundwork is laid

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investigated and documented
Investigated and Documented
  • 1- 5 eye elements
    • Problem Focused
  • 6 – 8 eye elements
    • Extended Problem Focused
  • 9 – 11 eye elements
    • Detailed
  • Comprehensive
  • 12 eye elements & 1 systemic element

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billing levels
Billing levels
  • Are determined by the number of areas of the examination process investigated

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what about the refraction
What about the refraction?

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refraction
Refraction
  • May be a routine portion of the examination
  • However
  • Is not a medical test
  • IS refractive (92000)
  • Is to be separated from medical procedures

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how do we get to the coding
How do we get to the coding
  • Diagnosis & Management Options
  • Data Complexity
  • Risk

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diagnosis management options
Diagnosis & Management Options
  • Straight forward
  • Low complexity
  • Moderate complexity
  • High

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data complexity
Data Complexity
  • The doctor determines
  • Levels
    • Minimum
    • Limited
    • Moderate
    • Extensive

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slide42
Risk
  • Presenting Problem
  • Diagnostic Procedure
  • Management Options

Minimal – Low – Moderate - High

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decision making
Decision Making

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new patient
New Patient

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established patient
Established Patient

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what if you did not document
What if you did not document
  • Lower coding
  • Lower billing level

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you play an important role
You play an important role
  • Documentation
  • Follow through

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efficient recording of procedures
Efficient Recording of Procedures
  • Leads to
  • Higher levels of procedure levels
  • Higher billing levels

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you can and do make a difference
You can and do make a difference

Luebbert Consulting & Training

enjoy nebraska optometric conference experience
Enjoy Nebraska Optometric Conference Experience

Jill J Luebbert, CPOT, ABOC

jill@jjlconsulting.com

www.jjlconsulting.com

Luebbert Consulting & Training