Hindsight is 20/20, especially as you reflect on your 2017 eye care services coding. As you ponder things you wish you knew at the start of the year that would have made a difference in your claims accuracy, don’t wallow in regrets—see it as a learning experience.
Coders, providers, billers and managers, you’ve only got a few weeks left to get up to speed on 2018 ophthalmology coding and billing updates and put your new year coding plan in place.
ICD-10 Coding Changes for Blindness and Low Vision
Introduced with the coding rollouts on Oct. 1, 2017 were over 420 new codes, 123 deletions, and over 270 ICD-10 changes. The ones that will most significantly impact eye care professionals are in reference to coding for patients presenting with blindness and low vision. Here is a quick synopsis of what lies ahead:
Degenerative Myopia Codes. Degenerative myopia is a medical condition—paid under the patient’s medical plan—associated with significantly increased risk of retinal detachment and other degenerative changes in the posterior segment of the eye. The 2018 changes allow for greater specificity in reporting.
The new codes are combination codes, so you only report one code, not two. They end with a fifth letter character indicating Degenerative Myopia:
A. with choroidal neovascularization
B. with macular hole
C. with retinal detachment
D. with foveoschisis
E. with other maculopathy
Blindness and Low Vision Codes. There are over 50 new 2018 codes added to the blindness and low vision code set. These new codes enable you to code the right and left eye with different categories of blindness, or to report blindness in one eye and low vision in the other, along with subcategories of each.
Keep in mind, there are legal implications with the blindness and low vision codes, based on set definitions for these conditions by the World Health Organization (WHO), which defines blindness and low vision. There’s no reason to report blindness because you’re treating what’s causing the blindness, not the blindness itself.
Bottom line: When coding for blindness and low vision, use precise language that matches ICD-10 terminology.
New Medicare Cards Coming April 2018
As Medicare phases out using patient Social Security numbers, subscribers will have new beneficiary cards with an alphanumeric identifier. To prepare for the new Medicare Beneficiary Identifier (MBI) rollout, you should implement and test this feature in your practice management software before April 2018, which is when you’ll start seeing these new cards. Be sure to remind all your Medicare patients to bring the new cards once they receive them.
Strive for Comprehensive Coding
Your goal should be 100-percent accurate and compliant coding and billing to audit-proof your clinic. As you code, remember to:
- Support the medical necessity to secure your reimbursement
- Avoid using the “unspecified” code which often leads to denials
- Tell the complete story of what is wrong with your patient
- Follow proper coding guidelines for sequencing and secondary codes
Don’t forget to check out the Medicare Learning Network (MLN), a training program funded by Medicare. There are a number of general medical coding and billing courses as well as one on ICD-10. Have someone in your office completely new to medical billing? The MLN offers training on topics including:
- Requirements for Determining Coverage of Presbyopia-Correcting Intraocular Lenses
- Medicare Vision Services
- Glaucoma Screening
- Vision Rehabilitation for Elderly Individuals with Low Vision or Blindness
There’s a lot to stay on top of as the new year rolls around. You need to know how to appeal denied Medicare claims and keep up on the latest carrier-specific rules as well. Disease specificity affects your coding claims in 2018, with updated ICD-10 and CPT® guidelines concerning carrier reimbursement relating to keratoconus, pterygiums, amblyopia, glaucoma and cataracts. You need formal coding training!
See Through an Expert’s Eyes
Expert ophthalmology consultant Jeffrey Restuccio provides insights on the 2018 ICD-10 and CPT® code updates for eye care in an audio conference for ProfEdOnDemand, “2018 ICD-10, CPT® and Medicare Updates for Ophthalmology.” In this session Jeffrey outlines all the additions, revisions and deletions, Cat II and III changes, and correct use of CPT® codes in eye care. This session will also cover Medicare updates with common diagnostic procedures, the basics like LCDs, E/M guidelines, office visits (with both E/M and 920xx codes) and incident-to rules, and how Medicare Advantage is different.
