Part 3 Filing 3 rd Party Claims

1. Part 3Filing 3rd Party Claims Addressing: 99000 Evaluation and Management Coding

2. Disclaimers This information was prepared by the 3rd Party Consultant to the Nebraska Optometric Association, Ed Schneider OD. To the best of his knowledge, it was current and accurate at the time it was prepared. It is not guaranteed to be error or omission free. It was prepared as general information to assist doctors and staff, and is not intended to grant rights or impose obligations.

3. Disclaimer • The ultimate responsibility for the correct submission of claims and compliance with provider contracts lies with the provider of services. • The Nebraska Optometric Association, and its presenters, agents, consultants and staff makeno representation, warranty, or guarantee that this presentation and/or its contents are error-free or omission-free, and will bear no responsibility or liability for the results or consequences of the information contained herein.

4. BOTTOM CMS-1500 Service & Materials Supplied

5. Coding the Services You Provided • Must correctly code the level of care provided • Practitioner is ultimately responsible for correct coding • Under-codingis as incorrect as over-coding

6. Reference Current Procedural Terminology, or CPT Updated annually, so needs to be replaced annually. • Covers • Examination coding, • Ancillary testing coding • Some dispensing and CL coding.

7. Examination Coding • Medical Exam Coding: • Uses CPT coding…either the • 92000 Ophthalmology Codes, or • 99000 Evaluation & Management Codes • Routine Exam Coding: • Definitions unique to each routine 3rd Party • Follow definitions & directions in Provider Manuals

8. Evaluation and Management Coding • There are three Key Components • History • Examination • Decision Making 99000 Evaluation and Management Codes

9. Chief Complaint • A brief explanation of why the patient is in the office. • The Chief Complaint drives the encounter • To bill a medical insurer, the chief complaint must demonstrate Medical Necessity

10. Chief Complaint • Examples of Medical Necessity: • Eye pain • Red eye • Loss of Vision • Flashes and Floaters • Evaluation and management of • Cataracts • Macular Degeneration • Glaucoma

11. Chief Complaint • Examples of NOT Medically Necessary • Routine exam • Checkup • No complaint • Need new glasses • “Blurred vision” w/ reading, driving, etc.

12. E&M Score Sheet Dr. Quack’s Evaluation and Management score sheet is… • Based on the 1997 E&M Guidelines for single organ systems https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/97Docguidelines.pdf • Unofficial, but should be helpful in determining the level of E&M exam code

13. OU Cataract Glaucoma Dry AMD hazy night driving or mod. headlights constant halos

15. 1 blepharitis 1 1 cataract 1 1 2 glaucoma susp. 1 4 7 <1

16. 58 min

17. Final Code must beReasonable and Necessary • Considering • History • Presenting Problem • Clinical findings

18. Thank You for Listening We hope this information has been helpful. Thank you for listening! See our NOA Website for more 3rd Party Educational Videos. 3rd Party Services Nebraska Optometric Association