Ophthalmology and Optometry Coding Alert

Although cataract surgeries are the most pressing open RAC issues, these auditors have announced dozens of other review issues within the past two months as well, indicating that they are stepping up their audits of the following services.

Your practice should take note of these audit areas to ensure that you aren’t at risk of scrutiny for these visits, which auditors in Regions two and three (RAC contractor Cotiviti) and Region one (RAC contractor Performant Recovery) are reviewing:

• Global Surgery: Pre- and Postoperative Visits: Overpayments associated with minor and major surgeries are under the microscope, including E/Ms billed during 10-day or 90-day global periods without modifiers, and E/M services billed the day of a minor (0-day) surgery without a modifier.
• Excessive Units of Hospital Services: Both initial hospital care and subsequent hospital care codes “are per diem services and may be reported only once per day by the same physician(s) of the same specialty from the same group practice,” Cotiviti said.
• Hospital Discharge Day Management Service: Medicare only pays one hospital discharge day management service per patient per hospital stay, which is billed by the attending physician of record only.
• Office Visits Billed for Hospital Inpatients: If you see a patient in the inpatient hospital setting, you should use a code from the 99221-99233 or 99238-99239 series, not a code from the 99201-99215 range, since these are reserved for outpatient visits.
• New Patient Visits: “Claims are recouped when a provider bills a new patient visit code and the same provider or a provider from the same group practice and with the same specialty has performed any other E/M services within a three-year period of time,” Performant says.