Ophthalmology and Optometry Coding Alert

The AAO, supported by the American Medical Association, urged CMS on May 17 to re-evaluate the role of medical decision-making as a component of the E/M codes and documentation guidelines.

Instead of basing the E/M coding strictly on level of severity, the Academy recommended simplifying the descriptors and using clinical examples to establish the severity of a medical problem.

"Severity is not an ideal surrogate for work," says Allan Jensen, MD, AAO senior secretary for advocacy, to the AAO. "A patient with a serious problem may have an obvious solution, while a patient with a less grave problem may undergo extensive evaluation and laboratory testing at the physician's request."

Though the Academy urged CMS to re-evaluate the medical decision component of the E/M services, they advocated for preservation of the current five levels of E/M service, history, examination, medical decision-making, nature of presenting problem, and time, in addition to the minimization of the need for counting these components of services.

According to the May 30 AAO Web site news release, the Academy's goals through the E/M revision process are to ensure that:

1.ophthalmologists are permitted to maintain current levels of E/M coding
2.medical specialties are not financially disadvantaged by revisions
3.CMS auditing criteria are user-friendly and easy to implement
4.the eye codes are maintained as a coding option.