In recent years, ophthalmology practices within ASC facilities have been steadily increasing. As the speciality has grown, our subject matter experts have gotten to dive more into the world of ophthalmology coding as they navigate the world of cataracts, glaucomas and beyond.
In chatting with our Coding Compliance Auditor, Micah, we have some tips - both big and small - that can positively impact the coding and claims within a center. Let’s dive in and chat about four tips Micah shared based on his experience working with ophthalmology coding.
Tip 1: Stay Updated on Cataracts Coverage
In the world of ophthalmology, cataracts are often the bread and butter; they make up a large percentage of procedures completed within an ophthalmology-focused facility. When asked what the most common denial is within ophthalmology claims, Micah said cataracts take the cake.
Micah says:
“Do you know what your local Medicare coverage articles state about cataracts? Typically, insurers base what those guidelines on Medicare guidelines, so understanding these articles will assist in reducing denials across all insurances. Specificity is the name of the game with cataracts in Medicare articles.”
Tip 2: Details, Details, Details
You know the old saying, “the devil’s in the details.” When it comes to coding, this statement holds especially true. Incorrect details can cause a variety of issues, from reimbursement delays to incorrect patient care following a procedure due to improper documentation. When writing an operative note, ensure that the dictation is stating the proper eye, eyelid, or approach. It sounds silly, we know, but getting those details on the op report can fall through the cracks. Without a simple identification of the eye in question, it can lead to cases that sit awaiting those details or denied claims for unspecified codes
Micah says:
“Make sure to note which eye is being treated, and confirm that the side referenced is correct. Both eyes being worked on? Make sure that both eyes are talked about in the description of the procedure. If something was different for one eye compared to the other, make sure those distinctions are clear.”
Tip 3: Get Specific with Glaucoma
As we said, details are crucial. Glaucoma is another key player in ASC ophthalmology practices, and requires an increased level of detail that other procedures may not call for. When coding glaucoma cases, it is important to know and notate the specifics:
- What type of glaucoma is the patient experiencing?
- Is it related to the patient's age?
- Which eye is this glaucoma present in?
- What stage is the glaucoma?
Notate, notate, notate. Questioning if a detail should be mentioned? It is better to include a detail that may not be needed than to leave out one that is essential - your coding team will appreciate the attention to detail!
Micah says:
“You can see different types of glaucoma in each eye or even the same type in both eyes but at different stages. These specifics are incredibly important for not only the coding process, but the patient’s records as well.”
Tip 4: Take Caution with Templates
Templates are a great tool, and are utilized by many ophthalmologists. Not only do they save time in the operative note process, but can also ensure all details are included when utilized correctly. As with all good things, there are downfalls that come with templates, too.
If using operative note templates, it is important to ensure their accuracy and not become complacent with the template that was initially implemented. Here are a few things to consider to keep your templates up to date and effective:
- Schedule quarterly template reviews
- Is your template missing information that has caused denials or coding delays? Touch base with your coding team to ensure all necessary components are in the templates and the information and options within the template is accurate / up to date.
- For example, your template may need to be updated in accordance with code changes. While eye stents used to be a category 3 code (0191T), it was recently made into new codes; did your team review your templates when this change took place, and ensure you understood the changes that occurred between the category 3 and the new codes to properly reflect this within your templates?
- Is your template missing information that has caused denials or coding delays? Touch base with your coding team to ensure all necessary components are in the templates and the information and options within the template is accurate / up to date.
- Confirm any and all checkboxes are completed before submitting for coding
- Did the physician check all necessary boxes? If some are left blank, it is easier to take a few minutes to be corrected immediately than to have the case’s coding delayed due to missing details.
Micah says:
“Using templates can be a great tool to complete an operative note in less time and without missing details, but requires the due diligence to make sure the tool is kept up to par, as an outdated template can cause more chaos than convenience.”
As ophthalmology within ASC’s continues to grow, our in2itive team is excited to bring more tips and insights from the coding space and beyond.
Is your eye center in need of coding or revenue cycle assistance? Let’s connect! Our team of specialists is here to help.