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Banishing the demons of coding and reimbursement
Ocular Surgery News heeds the call for more information to help navigate the world of coding and reimbursement.
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Ophthalmologists and practice administrators are faced every day with making value judgments when coding for procedures. All of this is done with the knowledge that there is a wide interpretation of the rules, that random audits are a real possibility and that even the experts do not agree on the fine points of coding and reimbursement.
Members of the Ocular Surgery News Editorial Board and Industry Advisory Council recently expressed to us the need for additional information to help them and our other readers navigate the world of coding and reimbursement. More to the point, some ophthalmologists have said that these are the very topics, with all their legal, ethical and financial implications, that keep them awake at night. It is this expression of fear and loathing on the topics of coding and reimbursement that led us to offer this special supplement to the readers of Ocular Surgery News.
Coding and reimbursement challenges
The challenges of coding and reimbursement are vast. They include daily challenges not only of using the right code, but also of citing the correct diagnosis, recognizing global fee periods, coding properly for emerging technology and using modifiers properly. They also include ongoing challenges such as developing and monitoring a compliance plan; chart audits; random audits by Medicare and insurers; and evaluating and resolving a coding error. Increased knowledge in these areas and knowing who your advocates and advisors are will help you avoid problems and increase income.
Advocates
Fortunately, you do have advocates for your coding and reimbursement causes. Ophthalmic representation on the American Medical Association CPT Advisory Committee include Stephen S. Lane, MD, American Society of Cataract and Refractive Surgery; Michael X. Repka, MD, American Academy of Ophthalmology; and Charles B. Slonim, MD, Contact Lens Association of Ophthalmologists. In addition, these associations lobby for changes in codes and for adequate and appropriate reimbursement.
Below the legislative level, ophthalmologists have certified coding consultants and health law attorneys to assist them in making wise choices related to the wide interpretation of the coding and reimbursement rules. These same health law attorneys can assist you when you are faced with an audit.
Authors
As an educational source above and beyond these advocates, Ocular Surgery News has gathered specialists to discuss coding and reimbursement. Their contributions seek to address error prevention, audit avoidance tactics, error evaluation and resolution, compliance plan development and special considerations for ASC billing and coding. We appreciate their time and effort in developing articles on such important topics.
We hope you find this supplement worthwhile and educational.
Richard L. Lindstrom, MD
Chief Medical Editor
Ocular Surgery News
For Your Information:
- Richard L. Lindstrom, MD, can be reached at Minnesota Eye Associates, 710 E. 24th St., Suite 106, Minneapolis, MN 55404; (612) 813-3600; fax: (612) 813-3660; e-mail: rlindstrom@mneye.com.