How Much are You Leaving on the Table?
By Mark Wright, OD
A patient calls the office during normal hours (let’s say at 2 pm) and complains of pain in the right eye that started two days ago and is getting worse. Your staff squeezes them into the schedule before the end of your normal day (3 pm) today. What could you bill?
EMERGENCY EXAM
This is an emergency exam. Your schedule is disrupted and your other patients are being inconvenienced in order for you to examine and treat this patient. There are codes for an emergency exam. They are:
99050 After hours
99051 During scheduled evenings & weekends
99058 During normal hours
99060 Out of office, disrupts schedule
Based on this case you should code and bill CPT: 99058
Note: Some third parties will pay for the emergency exam and most will not. You need to know the payment policy of the carriers in your area in order to collect from the patient while they are in your office.
Key Point: Never tell the patient you will bill them.
This is a formula for failure. The fee is due when the service is rendered. If the third party does not cover the emergency exam, then fill out an ABN and have the patient sign it as an intake form before you provide the service.
OFFICE VISIT
Intent is the big issue here. A classic example: The patient stopped first at the general physician’s office to find out the problem was a corneal foreign body (CFB), then the GP sent the patient over to you to remove the CFB. If the intent when the patient enters your office is for you to remove a corneal foreign body, then you cannot bill both an office visit and a CFB procedure.
On the other hand, if the patient enters the office and you must examine the patient to determine the cause of the eye pain, then you can bill for both the office visit and a CFB removal. In our example, the patient came to you first with just the complaint of CFB. If this was an established patient, the chief complaint was eye pain, you documented a detailed medical history (with 4 HPI, 2 ROS, and 2 of the 3 PFS history), a detailed examination (9 physical exam elements) with moderate medical decision making (minor surgery with an Rx for medication), then you should code as follows.
Based on this case you should code and bill CPT: 99214
CORNEAL FOREIGN BODY PROCEDURE
You removed the corneal foreign body.
Based on this case you should code and bill CPT: 65222
NOTE: If you are still using paper records, for documentation purposes, make sure you use a separate piece of paper to document the CFB removal. Also make sure you document: informed consent, the procedure, any medication with dosage used, an outcome statement (the most common outcome statement is “Patient tolerated procedure well”) and discharge instructions.
CORNEAL DEBRIDEMENT
Our patient waited two days to come into the office. The metal in his eye sat in salt water for two days rusting. This often leaves a rust ring which must also be removed. Code and bill for this, as well.
Based on this case you should code and bill CPT: 65435
OCULAR PHOTOGRAPHY
You should take before and after pictures of the wound. (NOTE: You only get to bill this once per day so you cannot bill for both pictures.)
Based on this case you should code and bill CPT: 92285
BANDAGE CONTACT LENS
If you used a bandage contact lens to manage the wound, then you should bill for that as well.
Based on this case you should code and bill CPT: 92070
PQRI
Do you want to take your coding up another level? Then don’t forget to bill for PQRI. If the patient is 18 or greater years old, if you coded an office visit between 99212–99215 or 9920–99205 and if you assessed the tobacco use of this patient and found out they were a non-smoker, then you can use the following PQRI codes:
Based on this case you should code: 1000F and 1036F
PQRI
If you documented a list of medications with dosages and verification with parent or authorized representative, then you would code:
Based on this case you should code: G8427
NOTE: For more help on PQRI coding, download the pdf on PQRI and e-prescribing from the AOA web site. You must be an AOA member. It’s worth the dues payment for this access.
E-PRESCRIBING
In 2009, three codes were required for e-prescribing:
G8443 Prescriptions generated via qualified e-prescribing system
G8445 Qualified e-prescribing system available, but no prescriptions generated during the encounter
G8446 E-prescribing system available but not used for one or more prescriptions due to patient/system reasons
For 2010, the codes have been reduced to only one. Only G8553 needs to be reported when a prescription occurs. This simplifies the coding. To qualify for the incentive, the doctor only needs to have 25 reported uses of the G8553 code.
If you coded an office visit using 92002, 92004, 92012, 92014, 99201-99205 or 99211-99215 and have a qualified e-prescribing system (currently there is an exemption for computer generated faxes), then you should code:
Based on this case you should code: G8553
Now...Assess Your Coding Proficiency.
Well, how did you do? Did you use all the codes listed above? Are there areas where you were giving away services? You should be reimbursed for the work you are doing.
Don’t stop here. Do this exercise for every medical procedure you do in your office. It’s well worth the time!
Now it’s your turn. Please scroll up and take our coding and billing survey in the right-hand column.