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Coding for Glaucoma & Glaucoma Suspects

Coding for Glaucoma & Glaucoma Suspects. Coding for Glaucoma & Glaucoma Suspects. Glaucoma Risk Factors – file://localhost/Users/alanhomestead/Documents/My Documents A 2-25-13/Pathology, Education, Pharmaceuticals 8-15-08/Glaucoma/Tests Procedures/Risk/Glaucoma Risk Factors.xls.

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Coding for Glaucoma & Glaucoma Suspects

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  1. Coding for Glaucoma & Glaucoma Suspects

  2. Coding for Glaucoma & Glaucoma Suspects • Glaucoma Risk Factors – • file://localhost/Users/alanhomestead/Documents/My Documents A 2-25-13/Pathology, Education, Pharmaceuticals 8-15-08/Glaucoma/Tests Procedures/Risk/Glaucoma Risk Factors.xls

  3. Coding for Glaucoma & Glaucoma Suspects Office visit, 92 or 99 Frequency: -As medically indicated (q 1mo, 3mo, 6mo, 12mo) -No limit on office visits

  4. Coding for Glaucoma & Glaucoma Suspects Special Tests Scanning Imaging (GDx, OCT) Pachymetry Visual Fields Fundus Photo Serial Tonometry Gonioscopy Extended Ophthalmoscopy

  5. Coding for Glaucoma & Glaucoma Suspects Special Tests Scanning Imaging (GDx, OCT) Pachymetry Visual Fields Fundus Photo Serial Tonometry Gonioscopy Extended Ophthalmoscopy

  6. Coding for Glaucoma & Glaucoma Suspects Scanning computerized ophthalmic diagnostic imaging, 92132 Anterior segment 92133 Posterior segment, optic nerve 92134 Posterior segment, retina

  7. Scanning Imaging Indications, Diagnosis Codes, Frequency Medicare LCD Noridian: Retired CGS: Yes WPS: Yes Novitas: Yes Palmetto: No

  8. Scanning Imaging Indications, Diagnosis Codes, Frequency Medicare LCD Retired LCD: Guidelines not rules List of ICDs handy No LCD: Clinical judgment allowed

  9. Scanning Imaging Indications, Diagnosis Codes, Frequency Medicare LCD Diag. code = primary test of medical necessity

  10. Scanning Imaging Indications, Diagnosis Codes, Frequency Non-Medicare Every plan has own rules Clinical judgment May follow Medicare

  11. Scanning Imaging Interpretation & Report Yes

  12. Scanning Imaging Interpretation & Report - Medicare Address the findings, relevant clinical issues, and comparative data (when available)

  13. Scanning Imaging Interpretation & Report Suggestions: • Succinct • Test reliability (patient compliant, quality of result) • Results (better, worse or same) • Noteworthy findings • Diagnosis

  14. Scanning Imaging Interpretation & Report Suggestions: • Impact on treatment (no treatment, further test/surgery/consult, continue/increase/decrease/stop/add meds) • Impact on prognosis • Physician signature

  15. Scanning Imaging Interpretation & Report - Location No requirement for specific location of I&R I&R can be: On the test printout/result On a separate paper In chart notes as discrete entry with other E/M services

  16. Scanning Imaging Interpretation & Report Should be easily identified as I&R and not part of exam Should be readily available in case of audit

  17. Scanning Imaging Unilateral / Bilateral CPT: unilateral or bilateral Medicare: Bilateral since 1/1/11 Non-Medicare: No universal rule, may follow Medicare

  18. Scanning Imaging CCI - Correct Coding Initiative Code pairs which are not billed together (usually)

  19. Scanning Imaging CCI 92132 + 92133 (-59 ok) 92134 (-59 ok) 99211 (-59 ok)

  20. Scanning Imaging CCI 92133 + 92132 (-59 ok) 92134 92250 (-59 ok) 99211 (-59 ok)

  21. Scanning Imaging CCI 92134 + 92132 (-59 ok) 92133 92250 (-59 ok) 99211 (-59 ok)

  22. Scanning Imaging CCI Exceptions Different anatomical site: R eye & L eye. Different patient encounter on same day. Different lesion (disease). 99211: Ok if extra tests ordered - VA, IOP, etc.

  23. Scanning Imaging Doctor Order Yes Physician must clearly document in medical record his intent that the test be performed TC, 26 breakout indicates need for Doctor Order

  24. Scanning Imaging Supervision Level General Responsible doc must be somewhere on earth, but does not have to be in office

  25. Coding for Glaucoma & Glaucoma Suspects Special Tests Scanning Imaging (GDx, OCT) Pachymetry Visual Fields Fundus Photo Serial Tonometry Gonioscopy Extended Ophthalmoscopy

  26. Coding for Glaucoma & Glaucoma Suspects Pachymetry 76514 Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)

  27. Pachymetry Indications, Diagnosis Codes, Frequency Medicare LCD Noridian: Retired CGS: Yes WPS: Retired Novitas: No Palmetto: Yes

  28. Pachymetry Indications, Diagnosis Codes, Frequency Medicare LCD LCD may say: Once in a lifetime for Glc. Susp. No limit on non-glaucoma Clinical judgment if no LCD

  29. Pachymetry Indications, Diagnosis Codes, Frequency Non-Medicare Every plan has own rules Clinical judgment May follow Medicare

  30. Pachymetry Interpretation & Report No

  31. Pachymetry Unilateral / Bilateral CPT: unilateral or bilateral however…

  32. Pachymetry 3rd Party Paying Unilaterally(once each eye) Cigna First Choice Regence – Blue Shield Bill it twice w/ modifier RT & LT, & paid twice

  33. Pachymetry 3rd Party Paying Bilaterally(once for both eyes) Medicare Aetna (1 per life glc & susp) Premera – Blue Cross UMP (1 per life glc & susp)

  34. Pachymetry CCI None Doctor Order Yes Supervision Level Does not apply

  35. Coding for Glaucoma & Glaucoma Suspects Special Tests Scanning Imaging (GDx, OCT) Pachymetry Visual Fields Fundus Photo Serial Tonometry Gonioscopy Extended Ophthalmoscopy

  36. Coding for Glaucoma & Glaucoma Suspects Visual Fields 92081 Limited (tangent screen, Autoplot, arc perimeter, or single stimulus level automated test)

  37. Coding for Glaucoma & Glaucoma Suspects Visual Fields 92082 Intermediate (at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test)

  38. Coding for Glaucoma & Glaucoma Suspects Visual Fields 92083 Extended (Goldmann VF with at least 3 isopters plotted and static determination within central 30 degrees, or quantitative, automated threshold perimetry, Humphrey full threshold 30-2, 24-2, or 30/60-2)

  39. Visual Fields Indications, Diagnosis Codes, Frequency Medicare LCD Noridian: Retired CGS: Yes WPS: Yes Novitas: Yes Palmetto: No

  40. Visual Fields Indications, Diagnosis Codes, Frequency Medicare LCD Clinical judgment if no LCD

  41. Visual Fields Indications, Diagnosis Codes, Frequency Non-Medicare Every plan has own rules Clinical judgment May follow Medicare

  42. Visual Fields Unilateral / Bilateral CPT: Unilateral or bilateral Medicare: Bilateral, Payment same whether test one or both eyes Non-Medicare: No universal rule, may follow Medicare

  43. Visual Fields CCI 92081 + 92082 92083 99211 (-59 ok)

  44. Visual Fields CCI 92082 + 92081 92083 99211 (-59 ok)

  45. Visual Fields CCI 92083 + 92081 92082 99211 (-59 ok)

  46. Visual Fields Interpretation & Report Yes Doctor Order Yes Supervision Level General

  47. Coding for Glaucoma & Glaucoma Suspects Scanning Imaging (GDx, OCT) Pachymetry Visual Fields Fundus Photo Serial Tonometry Gonioscopy Extended Ophthalmoscopy

  48. Coding for Glaucoma & Glaucoma Suspects 92250Fundus photography (no mention of instrument sophistication) (no mention of angle or resolution)

  49. Fundus Photo Indications, Diagnosis Codes, Frequency Medicare LCD Noridian: Retired CGS: Yes WPS: Retired Novitas: Yes Palmetto: Yes

  50. Fundus Photo Indications, Diagnosis Codes, Frequency Medicare LCD Clinical judgment if no LCD

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