Webinar

March 30, 2006

Topic: Ophthalmology/Optometry

Questions & Answers

These questions were directly related to the portion of the presentation being given, and may not be clear to anyone who was not present. If you have questions about coverage of Ophthalmology or Optometry billing, please see the billing guide, or contact customer service for assistance.

Question 1: Do we need to do anything for the password?

Answer 1: When you access the audio portion of the webinar you will need to give the pass code to the operator.

Question 2: Was the only printed material the Medicare Billing Guide?

Answer 2:  . Yes, participants were emailed the Guide to download and may download the webinar presentation for printing at the end of the presentation.

Question 3: If two ophthalmologists (both specialty code 18) are members of the same medical group, each possessing a sub-specialty certification (eg. Glaucoma specialist, retina specialist) must two previously scheduled patient appointments on the same day be combined or can they be reported as separate E/Ms?

Answer 3:  All services performed should be documented and the appropriate level of the E/M should be billed. Only one E/M should be billed.

Question 4: Can you supply the HCPCS code for the P-C IOL?

Answer 4: The code is V2632 for the IOL.

Question 5: Will you please provide some examples of “diagnostic and treatment” programs as indicated in codes 92002-92014?

Answer 5: The code states “initiation of diagnostic and treatment programs” and is part of the E/M. If, as a result of your exam, you determine additional services are needed, then you would initiate the action needed for those services and document that in your medical record.

Question 6: Does prescribing eyeglasses, for example, qualify as what constitutes “initiation of diagnostic and treatment programs?

Answer 6: Levels of coding and documentation instruction are not available through this webinar. Please contact your association for assistance with this level of documentation/coding.

Question 7: Have the guidelines for consult changed? If a patient is referred by an optometrist for cataracts, can the MD bill a consult or is it a transfer of care?

Answer 7: A referral does not constitute a request for consultation. A consultation requires a request for advice or opinion with a report of the findings back to the requesting physician.

Question 8: Are modifiers OD and OS no longer valid?

Answer 8: These modifiers are not listed in the CPT or HCPCS code books. Please use RT or LT.

Question 9: What are NHIC’s feelings regarding a specialist refusing to initially treat a patient until the PCP requests a consultation? Also, what about the specialist going back to the PCP and asking the PCP to amend his documentation to support a consultation request?

Answer 9: Medicare fee-for-service does not require a PCP to request a consultation. A beneficiary may go directly to a specialist for service. If you do not have documentation to support a consultation referral, you may bill the visit as a patient E/M service. Documentation must support the reason and necessity, as well as the level of service. A patient walking into a specialist’s office may be seen with a request for consultation. It would be treated as an E/M service.

Question 10: Per CMS, if a patient requests a consultation, the specialist should not report consultation codes. Is that accurate?

Answer 10: That is correct.

Question 11: Is NPI going to take the place of UPIN?

Answer 11: Yes, as of 5/23/2007.

Question 12: When should the LS modifier be used?

Answer 12: LS is used on all procedures for each beneficiary that is implanted with an investigational device.

Question 13: Dilated ophthalmoloscopy is included in a comprehensive exam for an E/M, correct? It should not be separately reported/billed, correct?

Answer 13: Please review the 95/97 documentation guidelines and the CCI edits on the CMS website to determine if the ophthalmoloscopy is covered in the E/M service.

Question 14: I would recommend AAOE and they have a list serve that allows people to ask each other questions about pertinent questions.

Answer 14: Thank you for the information.

Question 15: After cataract surgery we bill for 66983 with OD or OS. Where can I find an example of how to bill for the glasses?

Answer 15: Please contact the DMERC for your region as they process the claims for glasses.

Question 16: Eyetowncenter.com is also a good forum.

Answer 16: Thank you.

Question 17: The LS modifier should be added to 66984, as well as V2788, etc.?

Answer 17: Yes.

Question 18: Can I obtain CEUs?

Answer 18: This presentation is not certified for CEUs.

Question 19: Does DMERC have a website with examples for after cataract surgery glassed?

Answer 19: In California the site to access is : www.cignamedicare.com, in New England the site is: www.umd.nycpic.com/contactdme.html

Question 20: Where can I find additional information on the LS modifier?

Answer 20: Please review the billing guide.

Question 21: Please verify HCPCS V7288 is for presbyoptic lens or the non-presbyoptic lens.

Answer 21: Presbyoptic lens.

Question 22: Regarding glaucoma, when there is no retinal damage is part of tension check included?

Answer 22: Please review the NCCI edits.

Question 23: Are refractions covered during cataract surgery?

Answer 23: Refractions are not covered under Medicare.

Question 24: YAG 66821, where can I find more information?

Answer 24: Please refer to page 19 of the guide.

Question 25: How can I learn more about coding?

Answer 25: CMS is the best resource; however associations and coding centers will also be able to work with you.