OCT - Correct Coding for the 2011 Changes and Coding both OCT and Fundus Photos

[DAVID CLARK]

I get concerned when doctors require normative data bases to tell them what they are looking at. Sure normalized data is nice to have for the first visit, but after that the change in RNFL from visit to visit is what weighs the heaviest. Normative data to me is almost silly and pointless but we are told by large marketing efforts from large companies that you must have it. Why not look at the data provided to you and scrutinize it with out the normal values. After all RNFL thickness is just one piece of the puzzle.

[Stephen McDaniel]

I get concerned when doctors require normative data bases to tell them what they are looking at. Sure normalized data is nice to have for the first visit, but after that the change in RNFL from visit to visit is what weighs the heaviest. Normative data to me is almost silly and pointless but we are told by large marketing efforts from large companies that you must have it. Why not look at the data provided to you and scrutinize it with out the normal values. After all RNFL thickness is just one piece of the puzzle.

I'll have to disagree and I even think you contradict yourself. First you say:

"Sure normalized data is nice to have for the first visit, but after that the change in RNFL from visit to visit is what weighs the heaviest."

...and I agree

Then you say:

"Normative data to me is almost silly and pointless but we are told by large marketing efforts from large companies that you must have it."

Well...which one is it? Are Normative data bases "nice to have" or are ther "silly and pointless"?

Are you aware to what extent normative data bases are utilized in medicine? Your final statement:

"Why not look at the data provided to you and scrutinize it with out the normal values."

That one loses me. If you don't know what's normal you can NEVER classify pathology, and databases that compare patient data to thousands of "normals" is extremely valueable in my opinion.

[claudia ortiz]

[QUOTE=Robert Rebello;318798]This post is to answer the questions from Rebecca Schoonover

1. For the Interpretation and Report you suggested three things: Clinical Findings, Compare/changing conditions, and clinical management. Can these three things be written on the print out of the procedure or on the exam form in its own section called additional findings? For example with a visual field test (92083), would reliable, no changes, and repeat in one year be appropriate documentation?

First just to emphasize how important the Interpretation and Reports are. I did not suggest. They are all required. Yes as long as you document all three categories, you can have them on the visual fields (or any other instrument) report.

1. Can you show us an example on a 1500 form on how to bill correctly for the following: Patient with a corneal foreign body, pain, redness, and photophobia. How do I bill with correct (diagnosis and pointers) in the same day the Office visit, foreign body removal, and the bandage soft contact lens.

This is actually part of my Medical Coding and Reimbursement lectures. Your question perfectly demonstrates
one of the most common mis-coded and under billed encounters.

First, what most doctors do not realize that Medicare and most other payers consider the Foreign Body removal the entire “exam.” Therefore, most do not reimburse an exam code.

Here is what we show in EyeCOR for Corneal Foreign Body.

There are two procedure codes for Corneal Foreign Body

65220 Remove Foreign Body - Cornea w/o Slit Lamp
65222 Remove Foreign Body - Cornea w Slit Lamp

On average the one with Slit Lamp reimburses $20.00 more. So guess which one you use????

Another point here. I am sure that most of you already realize this, but most practice management systems have a limited number of ICD and CPT codes. Furthermore, their descriptions are not correct. EyeCOR has all codes for Optometry, Ophthalmology, Neuro-Ophthalmic, Neurology and Trauma. We also have the correct AMA descriptions.

What we have found is in many Practice Management Systems, there is only one code for Corneal Foreign Body Removal and it is the one without slit-lamp. Make sure you have the code 65222 in your system at the proper reimbursement.

Next how many times to you remove a rust ring or just clean up the Corneal Epithelium? Well that is a billable code. Most ODs do it but do not bill

65435 Removal Corneal Epithelium w/wo Chemocauterization

That procedure reimburses an average of $70!

Bandaged Contact Lens. If necessary you can protect the cornea with a Bandaged Contact Lens.

92070 Fitting of Contact Lens for Treatment of Disease - Includes Supply of Lens

That on average is another $70.

Now for the exam:

Since the Corneal Foreign Body diagnosis does not support the exam, what are the other complaints of the patient? “My eye hurts” or “I cannot see.” These are secondary diagnoses:

379.91 Eye Pain
368.8 Other Specified Visual Disturbances (Blurred Vision)

These support an exam.
Without the dates and places of services etc. The 1500 would look like this:

Dx1: 930.0
Dx2: 379.91

Procedures:
CPT Modifiers Dx Pointer Amount Units
65222 1 $65.80 1
65435 1 $71.34 1
92070 1 $70.90 1
99203 25 2 $103.29 1

TOTAL $312.33

Note these fees are not for your region.

Hello, How about if there is Foreign bodies in both eyes. What would be the correct way to bill??