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Medicare Compliance & Reimbursement

READER QUESTION; Differentiate Glaucoma Patient Coding Rules Based on Whether SNF Is Involved

Published on Mon Jan 12, 2009

If the patient comes to your practice from a skilled nursing facility, consolidated billing rules might apply.

Question: A wheelchair-bound nursing home patient came to our office for a follow-up glaucoma after beingon medication for a few weeks. What is the best way to code this office visit?

Answer: How you code for this visit depends on what your physician prefers, but you must choose one way and stick with it -- for all types of glaucoma and other eye patients.

Physicians often have to follow up with glaucoma patients because of medications or postsurgical concerns.Many practices differ in their coding method for follow-up visits, using either E/M codes or eye codes. Both sets are acceptable as long as they accurately depict the service. The decision usually depends on the physician's preference.

Some practices choose the eye codes because they require less documentation. However, the ophthalmologist must perform the required exam elements, and he must consider those elements medically necessary for the patient's presenting problem, to bill the appropriate eye code level.

In documenting follow-up glaucoma visits, be sure always to document a chief complaint even if it is simply "follow-up glaucoma."

Hidden trap: Billing can be complicated if the nursing home resident is a skilled nursing facility (SNF) patient. In that case, the nursing home is receiving a monthly payment from the Medicare program and is responsible for the payment for all the services the patient requires. The SNF, however, may deny payment, claiming they did not know your ophthalmologist was going to see their patient.

Disaster averted: Calling the nursing home before the ophthalmologist sees the patient to make sure the patient is not at SNF level -- and that you can bill Medicare -- will save you time and money in the future.

Note that even though the patient is from a nursing home, the place of service is always where she is seen -- in this case, she was seen in your office.

 

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