Optometric Billing-Why Good Billing Can Alleviate Your Fears

Watch the clip below. It was apparently posted to you tube by a disgruntled optometry student. If only this student had known about opticXpress!!

Did you know that using opticXpress as your billing service could alleviate over 80% of the problems reported in this video?!?!?!? Espescially diminishing returns!!! In fact, we have references that will prove it!!!

Case In point: One of our doctors billed 13k to insurance this month and we collected over 75% of it before adjustments!!!

Call opticXpress today...and don't wind up disgruntled like this student!

Optometric Billing-New Glaucoma Codes - THEY ARE REQUIRED!

***Pulled the following article from ODWire. As always, you can contact opticXpress for help with your optometric billing.

Robert E Rebello
EyeCOR

As of Oct 1, 2011 new Glaucoma codes went into effect. The majority of Optometrists and Ophthalmologists are unaware or do not have a complete understanding of these new codes. At three Optometry meetings in October, most doctors and their staffs had not heard about these new codes.

We at EyeCOR have put together this article explaining the new codes and their proper usage.

The new Glaucoma codes are “Stage” codes which specify the level or Stage of Glaucoma severity.

The new Stage codes are:

• 365.70 – Unspecified Stage Glaucoma
• 365.71 – Mild or Early Stage Glaucoma
• 365.72 – Moderate Stage Glaucoma
• 365.73 – Severe Stage Glaucoma
• 365.74 – Indeterminate Stage Glaucoma

Use the appropriate Stage code for the patient’s worst eye.

These Stage codes are secondary and coded immediately after the actual Glaucoma Diagnosis code. Stage codes cannot be used without the primary Glaucoma Diagnosis.

Note: These new codes are in effect for Medicare. Other payers are required to use the new codes beginning January 1, 2012. At this time other payers may not recognize them.

The following Glaucoma codes require one of the Stage codes:

365.10, 365.11 365.12 365.13, 365.20, 365.23, 365.31, 365.52, 365.62, 365.63 and 365.65

Do not use the Stage codes for Glaucoma Suspect or other glaucoma diagnoses not included above.

Coding Tip: We recommend not using either 365.70 or 365.74 as they are “Unspecified” or “Indeterminate.” Frequently payers deny reimbursement for Unspecified diagnoses. Instead code the specific Stage of Glaucoma.

Coding Tip: Make sure all procedures that point to the Glaucoma diagnosis using the Diagnosis Pointer (Form Locator: 24 E) point to the actual Glaucoma diagnosis not the Stage diagnosis (See Coding Example 1).

Coding Example 1 - Mild - Primary Open Angle Glaucoma:



Coding Example 2 - Glaucoma Suspect (No Stage code):



Other Ramifications when using the New Stage Codes

Most regions restrict certain procedures based on Severity levels. One example is the frequency limitations for Scanning Laser (OCT, GDx and HRT). Previously, for Advanced Glaucoma damage, you could perform up to 4 Scanning Laser procedures per year. Most regions currently do not allow any Scanning Laser for Advanced or Severe Glaucoma damage. Instead payers may allow up to 4 Visual Fields per year in order to track damage.

Therefore, when you code 365.73 – Severe Stage Glaucoma you will likely be denied reimbursement for Scanning laser. In addition, if you now code “Severe” Glaucoma and previously performed Scanning Laser on this patient, the payer may look back at previous claims and demand you return reimbursement for those procedures.

The current frequency limitations for Scanning Laser for most regions are:

Glaucoma Severity Level	Scanning Laser Frequency
Mild or Suspect Glaucoma	1 Time per year
Moderate Glaucoma	2 Times per year
Advanced or Severe Glaucoma	NO Scanning laser. Up to 4 Visual Fields

Avoid the temptation to stay away from the “Severe” glaucoma code. If you are audited and found to be using incorrect Stage codes, you could be in for more trouble.

Glaucoma Suspect Code Changes

In addition to the new Stage codes for Glaucoma, CMS has also changed the descriptions for two Glaucoma Suspect codes (365.01-.02) and adding two new codes (365.05 -.06). The new descriptions and codes are:

• 365.01 – Open Angle Glaucoma with Borderline Findings – Low Risk
• 365.02 – Anatomical Narrow Angle – Primary Angle Closure Suspect
• 365.05 – Open Angle Glaucoma with Borderline Findings – High Risk
• 365.06 – Primary Angle Closure Without Glaucoma Damage

The differentiation is Low and High Risk and Closure without Glaucoma Damage.

Make sure when coding Glaucoma Suspect, you use the codes with the description matching the patient’s diagnosis.

Glaucoma Severity Definitions

CMS defines Glaucoma severity as follows. Make sure you use the correct Severity Level based on the worst eye:

Glaucoma Suspect or Mild Damage (one or more of the following)

- Intraocular pressure >22 mmHg as measured by applanation.

- Symmetric or vertically elongated cup enlargement, neural rim intact, cup/disc ratio Greater than 0.4.

- Focal optic disc notch.

- Optic disc hemorrhage or history of optic disc hemorrhage.

- Nasal step or small paracentral or arcuate scotoma.

- Mild constriction of visual field isopters.

Moderate Damage (one or more of the following)

- Enlarged optic cup with neural rim remaining but sloped or pale, cup to disc ratio Greater than 0.5 & Less than 0.9

- Definite focal notch with thinning of the neural rim.

- Definite glaucoma visual field defect (arcuate/paracentral scotoma, nasal step, pencil wedge, constriction of isopters

Advanced or Severe Damage (one or more of the following)

- Severe generalized constriction of isopters (i.e., Goldmann I4e <10 degrees of fixation).

- Absolute visual field defects within 10 degrees of fixation.

- Severe generalized reduction of retinal sensitivity

- Loss of central visual acuity, with temporal island remaining

- Diffuse enlargement of optic nerve cup, with cup to disc ratio Greater than 0.8

- Wipeout of all or a portion of the neural retinal rim.

Summary
With the addition of the new Glaucoma Stage codes and new Glaucoma Suspect codes, proper coding can be complex. You need to ensure your practice is coding Glaucoma correctly. Otherwise, you could find your practice receiving unnecessary denials resulting in lost reimbursement.

For additional information contact EyeCOR:
Toll Free: 888-866-5367
Web: www.EyeCOR.com
Email: info@EyeCOR.com Copyright 2011 - Nteon Software LLC
EyeCOR is a register trademark of Nteon Software LLC

Optometric Billing-Jump On The iPad Bandwagon!

Thanks to our friends at the Noble Vision Group we finally have some content that reinforces our belief that tablet computers, especially Apple's iPad, are a great tool for any optometrist to use in their office. Not only can you use opticXpress' practice management software on them, but they are an excellent tool to use during an examination to not only record exam information and notes but also to bring up diagrams and other pictures of the eye to help educate patients. You will find that a tablet will not only help you perform essential office functions like optometric billing more efficiently but more importantly, a tablet will help you to engage and involve your patients more during an examination thus giving the patient the impression that you have performed a more thorough and efficient examination.

Read the article below and don't forget to contact opticXpress today to see how we can help you get started using tablets in your office!

More Apps for Eye Care: Orca Health’s EyeDecide MD

Has your medical practice jumped on the iPad bandwagon yet? There are more and more practices adopting the iPad or other tablets every day, utilizing all kinds of healthcare appsdesigned to improve efficiency, educate patients, and share information.

One of the major challenges in healthcare is patient education, and mobile apps are great tools for addressing this issue. It’s important for patients to understand what is going on with their bodies, why they are receiving certain procedures or medications, and how to take care of themselves after they leave their doctor’s office. Studies show that the current lack of health literacy can cost as much as $238 billion a year.

High patient volume, time constraints, and a lack of appropriate visual aids make it difficult for many doctors to effectively educate their patients.

The healthcare software developer Orca Health addresses this problem with their Decide Medical App Series, which features interactive 3D models of several anatomical parts.

If you’re involved in the eye care field, Orca’s EyeDecide MD is a great tool to use. Recently named one of the top iPhone medical apps of 2011 by Mobihealthnews.com, the app uses a highly detailed 3D model of the eye to illustrate several common conditions. Users can view the 3D model as a whole or as a cross-section, with the ability to toggle on and off layers of skin and bone, or expand the eye to view all the different parts.

You can even view photos and videos to analyze how common conditions affect the eye. If you have one of these conditions, EyeDecide MD will find your geo-location and show you nearby physicians on a map.

EyeDecide MD can be purchased in the iTunes app store for $4.99.

Click here to see some other great apps for the eye care industry.