Instructions: Ophthalmology and Optometry Coding Date: 21 March 2007 Time: 1110 - 1200

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2. Destinations. Take the perplexity out of coding Optometry and Ophthalmology servicesWhat constitutes a thorough eye examWhat\'s the contrast between utilizing an E

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Briefing: Ophthalmology and Optometry Coding Date: 21 March 2007 Time: 1110 - 1200

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Objectives Take the perplexity out of coding Optometry and Ophthalmology administrations What constitutes an exhaustive eye exam What's the contrast between utilizing an E&M code and an Eye exam code Understand the components of an Eye exam Bundling and unbundling of administrations Overview of E&M coding

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Key Providers (M.D.s or D.O.s) Medical specialists who represent considerable authority in eye mind Ophthalmologists Optometrists Opticians Technicians O.D.s, are eye specialists Eye mind proficient; not a specialist Optometric or ophthalmic specialists, help the above suppliers, encounter shifts

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Eye Anatomy

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Coding Systems ICD - 9-CM (Eye Related Dx) 360-379, V-codes CPT-4 ( Level I) (e.g., 92002–92014,92015–92396, 65091–68899, 99241-99245) HCPCS Level II (e.g.,G0117-G0118,S3000,S0810)

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Diagnosis Coding Rules Medical Necessity is controlled by the patient's determination ICD-9 codes ought to "connection" to each CPT Code what you know to be certainty (signs or side effects), not presumed analyze Code perpetual conditions when they apply to the patient's treatment (e.g., diabetes)

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Diagnosis Coding Rules DoD Extender Codes * "Experiences for DoD extraordinary visits, for example, flight, occasional, or end exams, are accounted for utilizing V70.5 with the suitable extender. Any condition analyzed amid the exam is recorded as an extra determination ." * MHS Coding Guidance:Professional Services and Specialty Coding Guidelines v2.0 2006 Services Coding Guidelines 2006 6.29.06

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Diagnosis Coding Rules Routine Eye Exams * Routine Eye Exams; **Without Complaints/Conditions ***With Complaints/Conditions * MHS Coding Guidance:Professional Services and Specialty Coding Guidelines v2.0 2006 Services Coding Guidelines 2006 6.29.06 Code Routine eye exams without protestations utilizing V72.0 ( examination of eyes and vision), any condition recognized amid the exam, code as extra diagnosis.**For Non-Active Duty Patients Code Routine eye exams with grumblings by posting the fitting V code as the essential dx and dissensions/conditions as optional dx. *** This applies to all patients, Active obligation or Non-Active Duty

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2007 ICD-9-CM Changes 377.43 Optic nerve hypoplasia (ONH); Present during childbirth, the optic nerve did not completely build up The correct cause is obscure, but rather it is every now and again connected with gestational diabetes or fetal liquor disorder Bilateral is more regular than one-sided Top 3 reasons for disabled vision of youngsters 377.49 was past code task for ONH

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2007 ICD-9-CM Changes 379.6x - New code arrangement to report for aggravation of postprocedural bleb; Post procedural blebs have 3 phases of contamination; Stage 1: bleb purulence Stage 2: direct irritation of foremost fragment Stage 3: serious torment, vitritis and intense visual misfortune may happen 379.6 Inflammation (disease) of post procedural bleb; 379.60 Unspecified 379.61 Stage 1 379.62 Stage 2 379.63 Stage 3

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Coding Rules Special Conditions - Diabetes Diagnosis Coding Rules 250.5x Diabetes with ophthalmic indications; For ophthalmic appearances because of Diabetes, the classification 250.5x code ought to be sequenced first , took after by the sign code(s) Example: Patient was determined to have Diabetic Retinopathy and has a background marked by Diabetes sort II 250.52 - Diabetes with ophthalmic signs, sort II 362.01 - Background diabetic retinopathy

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Coding Rules Special Conditions - Glaucoma Screening Glaucoma The term connected to a gathering of eye maladies that progressively result in loss of vision by forever harming the optic nerve Often is related with expanded Intraocular weight (IOP) The main source of irreversible visual deficiency Screening for Glaucoma incorporates An enlarged eye examination with an intraocular weight estimation An immediate ophthalmoscopy examination, or opening light biomicroscopic examination

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Coding Rules Special Conditions - Glaucoma Screening Diagnosis Coding Rules *Glaucoma screenings For patients without an essential analysis of glaucoma, glaucoma screening is accounted for independently as V80.1 If this is a piece of a yearly exam, list the yearly examination V code of V70.5__2 took after by V80.1 as the second determination *MHS Coding Guidance:Professional Services and Specialty Coding Guidelines v2.0 2006 Services Coding Guidelines 2006 6.29.06

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Coding Rules Special Conditions-Glaucoma Screening Procedural Coding Rules If a screening exam for glaucoma was the main ophthalmic administration performed then code G0117 Glaucoma screening for high-hazard patients, outfitted by an optometrist or ophthalmologist OR G0118 Glaucoma screening for high-chance patients, outfitted under the immediate supervision of an optometrist or ophthalmologist

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Exam Codes Two sorts of exam codes Eye Exam and treatment codes 92002 and 92004 for new patients 92012 and 92014 for set up patients E & M codes Referrals 99201 – 99205, for new patients (not found in your facility inside 3 years) 99212 – 99215 for built up patients Consults 99241-99245

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E&M versus Eye Exam Codes There are particular documentation prerequisites for utilizing E&M codes AND 92xxx Eye Exam and Treatment codes They are not the same. The prerequisites are more particular and stringent for E&M codes. While the documentation necessities for E&M codes will fulfill the prerequisites for 92xxx Eye exam and Treatment codes – the invert is NOT valid.

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Eye Exam Codes New Patients 92002 Ophthalmological administrations: therapeutic examination and assessment with start of indicative and treatment program; moderate 92004 Ophthalmological administrations: restorative examination and assessment with start of analytic and treatment program; complete , at least one visits Established Patients 92012 Ophthalmological administrations: medicinal examination and assessment, with start or continuation of demonstrative and treatment program; middle of the road 92014 Ophthalmological administrations: medicinal examination and assessment, with start or continuation of symptomatic and treatment program; far reaching , at least one visits

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Visit Types New = A patient who has not gotten administrations from an optometrist or ophthalmologist doled out to the center in the previous three years

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Visit Types Established = A patient who was dealt with by an optometrist or ophthalmologist up to three years back, regardless of the possibility that that supplier is no longer appointed to the facility, is a set up patient

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Eye Codes-Level of Service Comprehensive versus Middle of the road

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General Ophthalmology There are 13 exam components that must be recorded to approve a coding level: Testing visual sharpness Gross visual fields Ocular motility Pupils Iris Eyelids and adnexae Conjunctiva Cornea Anterior chamber Lens Intra-visual weight Retina Optic circle

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Amsler framework Brightness keenness test (BAT) Corneal sensation Exophthalmometry General restorative perception Glare test History Keratometry Laser interferometry Pachometry Potential sharpness meter (PAM) Schirmer test Slit light tear film assessment and transillumination General Ophthalmology Bundled Procedures

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When to Use Eye codes versus E&M If at least nine exam components are recorded = an exhaustive exam (92014 or 92004) If three to eight of the exam components are reported = a middle of the road exam (92012 or 92002) If under three of these components are archived Use the most reduced level E&M code Level in light of the supplier's documentation (99201-new pt or 99212-99213 - est. pt)

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Coding Example A built up patient came in with a sub-conjunctival discharge; In this circumstance the supplier may record visual acuities, a short opening light exam, and give tolerant instruction. None of these administrations have particular procedural codes doled out to them and under three exam components were performed.

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E&M or Eye Exam Code? ANSWER E&M code (99212), Provider performed under three exam components. This does not meet the criteria for Eye exam codes 920xx., must have at least three exam components noted. We should Test Your Eye-Q

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Procedural Coding Rules Screenings * Visual Screenings *When doing a word related wellbeing screening use ** 99172 or ** 99173 (screening codes) for optometry These codes are not to be utilized with the Eye exam codes 92002, 92004, 92012, and 92014 codes *MHS Coding Guidance:Professional Services and Specialty Coding Guidelines v2.0 2006 Services Coding Guidelines 2006 6.29.06 ** CPT code 99172 must not be utilized with 99173

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Ophthalmology CPT and Documentation Requirements EXTENDED OPHTHALMOSCOPY WITH RETINAL DRAWING – 92225 (beginning)/92226 (ensuing) Use it just when you do a retinal assessment to record pathology It must be legitimately reported in the outline with finish, named retinal drawings The documentation of follow-up administrations (92226) must incorporate an appraisal of the change from past examinations

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Visual Field Testing Visual Field Testing is secured for finding and treatment of strange signs, side effects, illness or harm. Documentation in the record must set up therapeutic need for the administration including the recurrence of the administration. 92081 Visual field examination, one-sided or reciprocal, with understanding and report; constrained examination (e.g., digression screen, Autoplot) 92082 Intermediate examination (e.g., no less than 2 isopters on Goldmann edge or Humphrey suprathreshold programmed demonstrative test) 92083 Extended examination (e.g., Goldmann visual fields with no less than 3 isopters plotted and static assurance inside the focal 30°)

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E&M Coding Overview

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When To Use an E&M An