Coding and Billing

New Coding & Billing Rules for 2018

By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD

Feb. 7, 2018

Changes have been made to coding and billing protocol. These are the coding rules that are different this year, and how you should make the changes in how you submit claims for reimbursement.

Every year codes change. Sometimes definitions of codes are changed, sometimes codes are deleted, and sometimes new codes are added. Every year it is important to keep up with the changes so that your coding is appropriate.

ICD-10-CM Changes
The changes for 2018 for ICD-10-CM eyecare coding includes 57 new codes, 25 revised codes and eight deleted codes. A listing of these changes can be found here:

The new codes are for:
• Diabetes mellitus with ketoacidosis
• Degenerative myopia
• Blindness and low vision

The revised codes are for:
• Trichiasis
• Injury of optic tract and pathways
• Injury of visual cortex

The deleted codes are for:
• Blindness and low vision

The Medicare document ICD-10-CM Official Guidelines for Coding and Reporting for FY 2018 has been published. The document states, “These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself.” In other words, you need to read this document.

CPT Changes
There are no new or deleted CPT codes for optometry for 2018. There are two revised codes for optometry for 2018. The revised codes are 95930 and 0333T. The bolded words are the revisions.

95930 was revised to be: Visual evoked potential (VEP) checkerboard or flash testing, central nervous system except glaucoma, with interpretation and report.

NOTE: If you are using VEPs for glaucoma, you should code the Category III code 0464T which is: Visual evoked potential, testing for glaucoma, with interpretation and report.

0333T was revised to be: Visual evoked potential (VEP), screening of visual acuity, automated, with report.

Since the changes to both codes involves a report, we should review what is needed in a report. A good outline for your report is:

TESTS & RELIABILITY OF THE RESULTS
Reliable
Unreliable

COMPARATIVE DATA (CHANGES SINCE THE LAST TEST)
First test ever done
Improved
Stable
Worsening

CLINICAL MANAGEMENT (IMPRESSION, ASSESSMENT & PLAN)
(Change to the plan as a result of the additional tests)
Remember the documentation rule that if you identify anything as a problem, you must further describe it in words or pictures. This rule applies to your reports as well as your medical documentation.

Follow this outline for your report, and it will contain everything an auditor is looking for in a report.

Education
Every year doctors and billing staff should have at least two hours of continuing education in coding and billing. If you need motivation, remember that it is the doctor who is audited, not the practice. It is the doctor who signed the contract with the providers saying they would code appropriately. It is an unacceptable defense to say that “I didn’t know what my staff was billing over my signature.” It is important to stay current with the changes that occur every year

 

References
https://customer.first-insight.com/downloads/Bulletins/ICD-10-CM-Code-Changes-EyeCare-10-1-17-MaximEyes.pdf
https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2018-ICD-10-CM-Coding-Guidelines.pdf

To Top
  
Subscribe Today Free...
And join more than 25,000 optometric colleagues who have made Review of Optometric Business their daily business advisor.
YOUR EMAIL
FIRST NAME
LAST NAME
  
Subscribe Today Free...
And join more than 25,000 optometric colleagues who have made Review of Optometric Business their daily business advisor.
YOUR EMAIL
FIRST NAME
LAST NAME