Optometry Coding & Billing Alert

Auditing downcoded evaluation and management claims can be a great way to ensure success on appeal. You can design an auditing tool that will work best for you, but here's a sample cover sheet you can use to summarize your findings for reviewers.

Patient Name: _______________________________  MR# ________________
Examined by: _______________________________  DOS: ________________
Service Type: _______________________________
Insurance: __________________________________  POL# ________________
CPT CODE BILLED: ________________________
History level:
Exam level:
Decision-making:
Time:
Length of visit:
Amount of time counseling and/or coordinating care:
CPT CODE SUPPORTED: ________________
(See attached for specifics of Hx, Exam & MDM)
Additional comments:____________________________________________________________
______________________________________________________________________________
Audited by: ______________________   Date: __________________
 
 Source: Erica Schwalm, compliance officer and reimbursement specialist, Pioneer Spine & Sports Physicians, West Springfield, Mass.