Ophthalmology and Optometry Coding Alert

Question: I've heard that I'm going to have to start changing which codes I report to UnitedHealthcare because they're changing their policies and implementing new bundlings, which may lead to denials. Is that true?

New Jersey Subscriber

Answer: To some degree, that may be true. In July, UnitedHealthcare (UHC) announced it would soon be implementing a new reimbursement policy. The carrier planned to begin following all of CMS' national Correct Coding Initiative (CCI) edits in November of last year.

"These edits, which follow correct coding guidelines established by CMS, will supplement edits currently administered under UHC's reimbursement policies, including the Rebundling Policy," UHC told its providers.

New date: UHC had to bump its original implementation date, and the new edits were rescheduled to take effect in December. According to UHC, until the carrier's system updates with the new edits, your reimbursement will continue to follow the past reimbursement policy. The new policy, once in effect, will apply to any services you report using the CMS-1500 form and its electronic equivalent.

-- Advice for You Be the Coder and Reader Questions provided by Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla.