Ophthalmology and Optometry Coding Alert

Professionals Reveal Their Professionals Reveal Their

Published on Sun Jun 01, 2003

Don't get mired down deciding on a proper treatment code: Using helpful coding tools will practically choose the code for you. Here are suggestions from experienced coding professionals for types of useful references that will meet your traditional, and newer, high-tech needs.

Don't Forget Your Medical Dictionary

When your office physician isn't available for you to check terminology you need for coding, or if you simply want to learn the meaning of a term or its pronunciation, where do you turn? To a dictionary, of course! If you haven't checked medical dictionaries lately, you may be pleasantly surprised to discover that some now publish multimedia versions.

Use your dictionary to help explain nonrecognizable diagnoses or diagnosis codes hard to locate in the ICD- 9-CM manual, or learn from the helpful illustrations, says Kandi Banks, RHIA, reimbursement specialist at Mariner Medical Clinic in Wisconsin. She also recommends a medical abbreviations dictionary to clarify abbreviations and acronyms.

A good medical dictionary is a lifesaver for proper diagnosis coding, says Brenda Arendt at the Center for Total Eye Care in Westminster, Md.

Use Current Coding References

Don't even consider using anything but the current versions of the CPT, ICD-9-CM and HCPCS manuals. Purchase them yearly to avoid rejected claims due to inaccurate or outdated coding.

Remember that the National Correct Coding Initiative (NCCI) edits are the authoritative source on what is or isn't separately billable. It's available by portions, should you not need the entire publication. Banks says that she uses this resource to avoid bundling and help ensure proper reimbursement. However, coders need to be careful applying the NCCI bundles to all insurance carriers before knowing how they processyour claims, says Raequell Duran, president of Practice Solutions in Santa Barbara, Calif.

Another useful type of book is a coder's reference. Banks uses one not only to explain the procedure codes but also because it's updated every year. A reference with detailed descriptions of CPT codes and information about NCCI edits, global periods, and correct diagnosis linking is a "tremendous learning tool," says Donna Marks, CPC, CCS-P, of Plaistow, N.H.

Get Help Online

Marks found that the Internet helped her be a better coder because she could learn about procedures themselves, as well as their associated risks and benefits. Learn to use www.lmrp.com, where you can view your local Medicare carrier's policies. Because about 80 percent of their patients are on Medicare, Banks uses this site to check on their local carrier coverage.

Educate Yourself

Don't overlook the power of seminars, workshops and conferences to help keep your coding and professional knowledge current, Arendt says.

Work as a Team With Your Ophthalmologist

You've checked your usual references, both hard-copy and online, and perhaps even posted your question to the ophthalmology e-mail newsgroup, and you still may have a coding question. What to do? Banks' gentle reminder is to consult with your physician. Arendt reinforces this suggestion, adding how she and the physicians interact on coding matters. "I can tell them what I learned, and they work with me to determine how we can use it." She adds that they respect her coding knowledge as much as she respects their medical degrees. Summing up her feelings about the benefits of being well versed in coding, she says, "Having confidence in what you are doing is by far the best coding assistance."

Because your physicians are held liable for the claims you send out on their behalf, they should be part of the decision-making when you are not sure if the claim information you are going to submit is 100 percent accurate.