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The article offers updated information on Medicare's "new patient" rule as of January 1, 2014. Topics discussed include Medicare's definition of "new patient," treatment codes subject to audit by the Centers for Medicare and Medicaid Services (CMS) under the new rule, and the new rule's implications to retinal practices. Also discussed is the financial impact of the revised rule to the health care industry.

The article discusses the clinical applications of Modifer 25, a procedural terminology, defined by the U.S. National Correct Coding Initiative in retinal medicine. The intravitreal injection as treatment is considered a minor surgical procedure including the treatment of wet age-related macular degeneration (AMD), branch retinal vein occlusion, and retinal detachment. The Current Procedural Terminology 67028 when used already includes the office visit.

The article discusses how U.S. practices can ensure the payment for multiple diagnostic tests performed on the same day is correct. It cites the application of the Multiple Procedure Payment Reduction (MPPR) on diagnostic imaging and the payment methodology instituted in 2013 by Medicare when more than one diagnostic test was performed by a single physician. It also notes the ophthalmology codes subject to MPPR and the calculation errors made by some Medicare Administrative Contractors (MAC).

The article looks at the most common coding errors in retinal surgery. According to the Current Procedural Terminology (CPT) manual, when conducting a lensectomy in conjunction with a vitrectomy the appropriate code is 66850, which involves removal of lens material. CPT code 67108 includes the repair of retinal detachment with vitrectomy. Meanwhile, CPT code 67113 includes the repair of complex retinal detachment.

The article looks at current procedural terminology (CPT) changes for retina/vitreous surgical coding. The combination of 67038 and 67108 for coding complex retinal detachment surgery with vitrectomy for retinal detachment with proliferative vitreoretrinopathy has been revised due to the termination of the CPT code 67038. Examples of clinical scenarios and the corresponding CPT coding for 2008 are provided.

The article discusses U.S. extended ophthalmoscopy medicare policy codes by medicare contractors National Government Services and Empire Medicare including 92225 code requirements on retinal drawing, acceptable diagnoses, and clinical findings report, and code 92226 for follow-up office visits.

The article provides information on the Current Procedural Terminology (CPT) codes and diagnosis codes to use for diabetic eye findings. The main eye diseases resulting from diabetes mellitus are mentioned including clinically significant macular edema (CSME), proliferative vitreoretinopathy (PVR), diabetic retinopathy (DR), retinal detachment (RD), neovascular glaucoma, vitreous hemorrhage (VH) and diabetic cataract.

The article focuses on the use of right coding for office visits and intravitreal injections. It says that global fee of Medicare includes payment for the office visits in the reimbursement for minor surgery. It states that modifiers 24, 25, and 57 are National Council on Compensation Insurance (NCCI) Inc.-associated modifiers for identifiable evaluation and management (E/M) service. It adds that the use modifier 25, which can break the NCCI bundle, needs to be controlled in its usage.

The article presents questions and answers related to eye surgery performed by non-retinal physicians including the use of modifiers 58. 78 and 79 coding for surgery and how to code a complex repair of posterior segment.

The article presents questions and answers related to vitreoretinal surgical coding including whether the patient who developed a retinal detachment during surgery to treat epiretinal membrane should bill the higher paying repair, when to use modifier 58, and how to code a pars plana vitrectomy/epiretinal membrane peeling/endolaser panretinal photocoagulation.

The article highlights audit prevention measures for physicians. Reading the revised National Coverage Determination (NCD) and complying with it, and being more proactive are some steps advised by the author in the move of the U.S. federal government to intensify its auditing. In terms of electronic medical records (EMR), the author suggests customizing one's electronic chart documentation and reviewing all patient entry for errors and revising them.

The article presents questions and answers related to coding for office-based procedure, including the billing of comprehensive eye examination, modifier for extended ophthalmoscopy in Medicare, and the evaluation and management (E&M) retina coding.

The article discusses compliance-related issues relating to intravitreal injections in the U.S. Physicians are advised to keep a log of all supplies and their usage and which patient was given what lot. A case example is presented in which the same vial was used for multiple patients, but multiple vials were ordered and subsequently sold. The required documentation for injections is explained. Questions and answers relating to intravitreal injections are also presented.

The article offers the author's insights on the Recovery Audit Contractor (RAC) audits in the Centers for Medicine and Medicaid Services (CMS) regarding its outdated National Coverage Determination (NCD) 80.3.1. It states that NCD 80.3.1 mandates that a flourescein angiography be conducted within 30 days before ophthalmic photodynamic therapy (OPT). It mentions that CMS received a formal written request to review the NCD 80.3.1 from the American Academy of Ophthalmology (AAO) on May 25, 2012.

The article presents questions and answers related to coding for ophthalmic surgery including if posterior capsulotomy performed with the vitrector billable when done together with retinal detachment repair surgery, and coding for removal of an infected orbital suture with the scleral buckle.

The article explains the specific circumstances for using Current Procedural Terminology (CPT) code 92014 and how the Comprehensive exam requirements vary from the Intermediate exam requirements. It presents the definition and requirements of the Intermediate and Comprehensive eye codes, including general medical observation and gross visual fields, respectively. Also discussed are the medical necessity issues with respect to these eye codes.

The article discusses tips on designing an electronic medical records (EMR) system. It cites Medicare's 1997 Documentation Guidelines for E/M Services to be a useful resource of information. It states that consultation with a healthcare lawyer is beneficial for legal purposes. The author suggests hiring a reimbursement or a compliance expert. Design tips are also offered which include chart documentation, content management system (CMS), and identification.

The article presents questions and answers related to vitrectomy with associated cataract and intraocular/crystalline lens surgery.

The article presents questions and answers related to posterior segment intraocular foreign body removal which include the management of a patient with sclera laceration without uveal prolapsed and the case of a patient who sustained trauma to the left eye resulting in a corneal laceration.

The article presents questions and answers related to office visit coding, such as billing of patient who comes in after an intravitreal infection, coding of patient's visit because of the development of new floaters, and whether a platelet rich plasma (PRP) patient who comes in after the development of vitreous hemorrhage can be coded or not.

The article reports on the inclusion of two new codes in Current Procedural Terminology for 2011. These codes are 92227 on remote imaging for detection of retinal disease and 92228 on remote imaging for monitoring and management of active retina disease. It discloses that these codes were established to provide a reporting mechanism for remote imaging and to meet the needs of diabetic retinopathy screening program. It provides advice on the new codes and gives examples on typical patient.

The article presents questions and answers related to retinal specialists and issues involving office visit/surgery modifier including billing for postoperative management, medicare policy for coding for office visits and another on billing for an established patient with a new complication.

The article presents questions and answers related to ophthalmology including whether a scribe can legally draw and color the drawing for extended ophthalmoscopy in a patient chart, whether Medicare can be billed for a visual field in a diabetic patient once a year if there are no ophthalmological findings, and whether one could bill for ophthalmoscopy/photos if there are no findings.

The article presents questions and answers related to scribing and extended ophthalmoscopy rules which include the scope of a scribe's work, the national policy on color drawings for extended ophthalmoscopy, and whether the procedure can be billed along with an eye code.

The author discusses the coding guidelines for optical coherence tomography (OCT) and fundus photographs in the context of treating wet macular degeneration using intravitreal injections. According to the author, fundus photos and OCT are bundled under the National Correct Coding Initiative when performed on the same day. The use of the words medical necessity in connection with fundus photos and OCT is explained, relying on an article written by Doctor Michael K. Rosenberg for the February 2002 issue of "Medicare Bulletin for Michigan and Illinois."

The article presents questions and answers related to optical coherence tomography (OCT) coding and billing including how often can perform retina OCT testing, the use of modifier 52, and the need to use special modifiers for OCT codes.

The article presents questions and answers related to the new retinal ophthalmic diagnostic testing codes for 2011 including billing with fundus photography, use of codes 92133 and 92134 on the same visit, and application of 92133 to an Optical Coherence Tomography (OCT) of the optic nerve.