Article: New Glaucoma Codes - THEY ARE REQUIRED!

[AdminWolf]

You can view the page at http://www.odwire.org/forum/content/...-ARE-REQUIRED!

[AdminWolf]

Thanks Bob for providing this update.

Just as a reminder, we'll be having a webinar with Bob in late November, his shows are always informative!

adam

[Richard Pagan]

Thanks Bob for providing this update.

Just as a reminder, we'll be having a webinar with Bob in late November, his shows are always informative!

adam

adam

anyway to make a "printer-friendly" option? first time I wanted to print something here and discovered no easy way to print, future feature maybe?

thanks

Rick

[AdminWolf]

adam

anyway to make a "printer-friendly" option? first time I wanted to print something here and discovered no easy way to print, future feature maybe?

thanks

Rick

Here's Bob's Original Article as a PDF.

cheers
adam


ODWire New Glaucoma Codes.pdf

[Sky Schroeder]

Here's Bob's Original Article as a PDF.

cheers
adam


ODWire New Glaucoma Codes.pdf

As I've said before, I appreciate what you and your pops do for us here on ODwire.

[AdminWolf]

As I've said before, I appreciate what you and your pops do for us here on ODwire.

Thanks, Sky! I'm just glad we've been able to provide a useful service over the years! We've got a few surprises up our sleeves for 2012, it should be a fun year.

cheers
adam

[Nick Weber]

I have not seen anything on this from the OOA

[Jonathan Warner]

I have not seen anything on this from the OOA

AOS had a email burst on this a couple of weeks ago.

[B Middaugh]

I received this clarification today which refutes the headline of this post "They are required". Looks like they aren't required after all.

Brad Middaugh***UPDATE - NEW ICD-9 CODES FOR REPORTING GLAUCOMAAfter further enquiry from First Coast (Florida Medicare Carrier) of Florida Medicare requirements, the TPC committee has determined that the new glaucoma codes are NOT REQUIRED for adjudication or to determine medical necessity for payment of claims. The codes are considered to be for secondary information and data gathering, but are not a requirement to process a claim.

Providers can include those staging codes if they so desire but it will not affect payment or processing of their claim with the carrier. As of now, they have received no mandate from CMS to require the codes and they have NOT added them to any LCD.

As of October 1, 2011, coding for glaucoma became more specific with the addition of new codes and new coding requirements. Medicare implemented the change effective October 1, 2011 and all other insurers will make the changes effective on January 1, 2012.

The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) is a medical classification that provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. Under this system, every health condition can be assigned to a unique category and given a code, up to six characters long. Such categories can include a set of similar diseases.The International Classification of Diseases is published by the World Health Organization (WHO) and used worldwide for morbidity and mortality statistics, reimbursement systems, and automated decision support in medicine. This system is designed to promote international comparability in the collection, processing, classification, and presentation of these statistics.Effective October 1, 2011, there were new classifications for the diagnosis of glaucoma presented. These changes were requested by the American Academy of Ophthalmology. The justification for these changes was driven by the concept that glaucoma is caused by damage to the optic nerve, and leads to vision loss. Patients present for treatment at different stages of the disease. It is important to identify the stages of glaucoma to monitor patient treatment and outcome. There are seven new codes and one revised code in this “glaucoma” category.

The new ICD-9 codes allow differentiating glaucomatous stages into mild, moderate, and severe disease.365.01 – Revised – Open angle with borderline findings, low risk.365.05 – New – Open angle with borderline findings, high risk.365.06 – New – Primary angle closure without glaucoma damage365.70 – New - Glaucoma stage, unspecified365.71 – New – Mild stage glaucoma365.72 – New – Moderate stage glaucoma365.73 – New – Severe stage glaucoma365.74 – New – Indeterminate stage glaucomaWhile the new codes may be used after October 1, 2011, they will not impact coverage, as current policies will continue to link to the primary diagnosis. Proper coding still requires use of the primary diagnosis to be the disease state, but now the stage of glaucoma should be reported on a second line. Both diagnoses should be linked to any Current Procedural Terminology (CPT) code used.

There were seven additional new and two deleted ICD-9 codes that effect Optometry as of October 1, 2011:173.10 New-Unspecified malignant neoplasm of eyelid, including canthus173.11 New-Basal cell carcinoma of eyelid, including canthus173.12 New-Squamous cell carcinoma of eyelid, including canthus173.19 New-Other specified malignant neoplasm of eyelid, including canthus379.27 New-Vitreomacular adhesionV19.11 New-Family history of glaucomaV19.19 New-Family history of specified eye disorder173.1 Deleted-Other malignant neoplasm of skin eyelid, including canthusV19.1 Deleted-Family history of other eye disordersThese changes will help prepare doctors for the ICD-10 conversion in October 2013 and are similar in concept to the recent PQRS initiatives of reporting “what you find.”

This ever changing landscape of codes for diagnosis and procedural codes has painted a whole new picture for eye care. For additional resources, refer to www.aoacodingtoday.com , www.aoa.reimbursementplus.com or send questions to AskTheCodingExperts@aoa.org.

[Robert Rebello]

We have already seen denials from early October claims. I don't know what Florida is saying but we looked up Florida's LCDs and they do not have the same information. Furthermore, CMS has stated that the new Glaucoma codes are required for those codes we discussed as of Oct 1st and effective for other payers starting January 1st 2012.

[AdminWolf]

We have already seen denials from early October claims. I don't know what Florida is saying but we looked up Florida's LCDs and they do not have the same information. Furthermore, CMS has stated that the new Glaucoma codes are required for those codes we discussed as of Oct 1st and effective for other payers starting January 1st 2012.

Just so everyone is clear -- Bob runs EyeCOR, the software that many practices use to properly code and process visits; this software is used all across the country.

So when he says that "he's already seen claims denied", what he means is that the users of the software have already seen claims denied, it isn't just his opinion, it is what is actually happening on the ground.

It is amazing how complicated all this is....

[Robert Rebello]

I am at the Tennessee Optometric meeting so it was difficult to respond fully yesterday.

There is no question CMS wants the new Glaucoma codes used. The problem is in the implementation by the regional payers. This is similar to the creation of the new Scanning Laser codes on 1/1/2010. It took months for some regions to correctly change their LCDs. Now, 10 months into the change, there are still a couple of payers denying the new codes and only accepting the deleted code 92135! Unfortunately, the payers just dont get it right or on-time.

What I strongly recommend is to closely watch your EOBs and follow these 4 scenarios:

• If you submit Glaucoma codes with the new Stage Codes (365.7x) and they are reimbursed… Great.
• If you submit Glaucoma codes without the new Stage Codes and they are denied… Start using the new Stage codes and rebill the denied claims.
• If you submit Glaucoma codes without the new Stage Codes and they are reimbursed… Good BUT you need to keep a close eye on EOBs. When they start being denied, you need to use the new Stage codes and rebill the denied claims with those new codes.
• If you submit Glaucoma codes with the new Stage Codes (365.7x) and they are denied… Stop using the Stage codes. Again keep a close eye on EOBs. When they start being denied, you need to use the new Stage codes and rebill the denied claims with those new codes.

The first two are obvious. The last two require that you or your staff closely monitor your EOBs. When I lecture across the country I always tell the doctors to look at their EOBs. It is your money! You need to make sure your billing staff is properly processing denied claims.

As we get more experience with how the various payers are handling these new Glaucoma codes we will report back. For those EyeCOR users, as always we will show you specifically for your region, how to implement the new codes.

[Kandi S. Moller]

How about glaucoma suspects or ocular hypertension? Use 365.04 or 365.01?

[Robert Rebello]

Because the diagnosis is "suspect" the new Stage codes do not apply. The new codes define the severity level (Mild, Moderate or Severe). Therefore, they only apply to the codes I listed in the article.