Match codes in order to avoid denials
The first reason for cataract co-management denials is the OD reporting a different diagnosis code than the ophthalmologist. If the code doesn't match up, one of those doctors is going to be denied, experts warn.
Here's what you can do: Stay away from across-the-board use of 366.10 (Senile cataract, unspecified) and retrieve the exact diagnosis code from the ophthalmologist prior to sending out a claim.
For instance: If the ophthalmologist uses 366.13 (Anterior subcapsular polar senile cataract), the optometrist should also code 366.13.
Do not miss: The same applies to matching the surgical CPT code you both are reporting. While 66984 applies to the majority of cataract patients, once in a while, the procedure will be difficult and the surgeon will code 66982.
Good tidings: As 66982 has a higher relative value than 66984, the postoperative care will also reimburse the OD at a higher level.
Make it a point to append modifier 55 to either 66984 or 66982 to correctly represent the post-op services you have provided.
Good idea: Insert a note on the claim form explaining that any documentation required is available upon request. May practices have successfully used this technique to stay away from denials.
The first reason for cataract co-management denials is the OD reporting a different diagnosis code than the ophthalmologist. If the code doesn't match up, one of those doctors is going to be denied, experts warn.
Here's what you can do: Stay away from across-the-board use of 366.10 (Senile cataract, unspecified) and retrieve the exact diagnosis code from the ophthalmologist prior to sending out a claim.
For instance: If the ophthalmologist uses 366.13 (Anterior subcapsular polar senile cataract), the optometrist should also code 366.13.
Do not miss: The same applies to matching the surgical CPT code you both are reporting. While 66984 applies to the majority of cataract patients, once in a while, the procedure will be difficult and the surgeon will code 66982.
Good tidings: As 66982 has a higher relative value than 66984, the postoperative care will also reimburse the OD at a higher level.
Make it a point to append modifier 55 to either 66984 or 66982 to correctly represent the post-op services you have provided.
Good idea: Insert a note on the claim form explaining that any documentation required is available upon request. May practices have successfully used this technique to stay away from denials.
Gather accurate fees with surgeon's input
Yet another common co-management billing mistake is overlooking changes in the surgeon's fee structure. It is vital to stay in the loop when the ophthalmologist increases her fees so you can earn the total 20 percent of the Medicare allowable to which you're entitled for postoperative care.
But then: That would only apply if the surgeon was charging less than the Medicare allowable, which is unlikely.
Remember: Many a time, the surgeon will provide initial postoperative care prior to transferring the patient to the OD. In this situation, it is important to coordinate on the number of days each doctor is providing care and enter those numbers on separate claim forms.
Watch out: Does the surgeon keep each patient the same number of days prior to referring back to you? That may command attention from insurers. If the surgeon always sends the patient back to you after the one-week visit, payers may suspect that you have a deal with the surgeon.
Find your share: To find out the split, first calculate 20 percent of the overall charge for the service. After this, divide that total by 90, which is the cataract postoperative global period. This provides you the per-day value of the postoperative management service. In the units field, write in the number of days of service your OD provides, which, multiplied by the per-day rate, will yield your total charge for the service.
Tip: The OD can assume care on the day after the patient is last seen by the surgeon.
Call the surgeon after you see the patient to figure out if she's filing for postoperative care and, if so, how many days she'll report so that you can bill for the balance. This is also good time to remind that office to include modifier 54 on its claim form, or else you run the risk of the payer denying your co-management claim.
Give this a try: If the surgeon is not already using a postoperative form that covers all the bases, offer to help design one. A good form could show the surgery date, which eye the surgeon treated (if not both), the surgeon's postoperative care dates, and the number of days that represents. What's more, the form could point to the date and the OD assumed care, the initial refraction, and the resultant acuities. E-mail or fax this completed form back to the surgeon to share the record of the patient's continuing care.
Yet another common co-management billing mistake is overlooking changes in the surgeon's fee structure. It is vital to stay in the loop when the ophthalmologist increases her fees so you can earn the total 20 percent of the Medicare allowable to which you're entitled for postoperative care.
But then: That would only apply if the surgeon was charging less than the Medicare allowable, which is unlikely.
Remember: Many a time, the surgeon will provide initial postoperative care prior to transferring the patient to the OD. In this situation, it is important to coordinate on the number of days each doctor is providing care and enter those numbers on separate claim forms.
Watch out: Does the surgeon keep each patient the same number of days prior to referring back to you? That may command attention from insurers. If the surgeon always sends the patient back to you after the one-week visit, payers may suspect that you have a deal with the surgeon.
Find your share: To find out the split, first calculate 20 percent of the overall charge for the service. After this, divide that total by 90, which is the cataract postoperative global period. This provides you the per-day value of the postoperative management service. In the units field, write in the number of days of service your OD provides, which, multiplied by the per-day rate, will yield your total charge for the service.
Tip: The OD can assume care on the day after the patient is last seen by the surgeon.
Call the surgeon after you see the patient to figure out if she's filing for postoperative care and, if so, how many days she'll report so that you can bill for the balance. This is also good time to remind that office to include modifier 54 on its claim form, or else you run the risk of the payer denying your co-management claim.
Give this a try: If the surgeon is not already using a postoperative form that covers all the bases, offer to help design one. A good form could show the surgery date, which eye the surgeon treated (if not both), the surgeon's postoperative care dates, and the number of days that represents. What's more, the form could point to the date and the OD assumed care, the initial refraction, and the resultant acuities. E-mail or fax this completed form back to the surgeon to share the record of the patient's continuing care.
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