Ophthalmology and Optometry Coding Alert

Tip: Use G8300 as your test code

You should be modifying your office and billing systems, CMS official Susan Nezda said during an April 19 conference call on the PQRI. You need to figure out which role each team member will play in the reporting process, and educate all of your staff. You can use tools such as worksheets, encounter forms and screen templates to capture the data.

Important: You should test your systems before the July 1 start date to make sure your vendors are up to snuff, Nezda said. Verify that your practice management or billing system can bill out a zero charge, says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates in Clearwater, Fla. Also verify that your clearinghouses will accept these new HCPCS codes and modifiers and pass them on to the carriers you work with. -For systems that cannot do -0,- the guidelines allow for a nominal amount, such as 1 cent.-

How it works: You-ll report quality measures and CPT category II codes on the same CMS-1500 form you use to bill for your clinical services. Enter a -0- charge in box 24F on the 1500 form for these quality measure codes.

You can test out your PQRI claims submission now. CMS designated G8300 as a test code, so you can try adding G8300 (Clinician documented that patient was not an eligible candidate for optic nerve head evaluation during the reporting year) as a line item on any claim, or in field 24D on the 1500 form, and enter $0.00 or $0.01 as the line item charge. Then check your remittance advice (RA) to make sure the carrier or contractor processed the test code. You should see RA remark code N365, which denotes a non-payable code used for information purposes only.

-I just recently added the test code G8300 to several Medicare claims to be transmitted electronically. I have not heard of any glitches yet regarding these test claims,- says Rita Knapp, CPC, chief compliance officer and senior billing specialist at Abrams Eyecare Associates in Indianapolis.

Deadline: CMS will consider your quality reporting only for claims that reach the National Claims History (NCH) file by Feb. 29, 2008. You can't resubmit claims just to add the quality-reporting codes, nor can you submit the quality-reporting codes by themselves on a separate claim.