jill j luebbert, cpot, aboc. luebbert consulting & training

Technician’s Role in Medicare Compliance

Jill J Luebbert, CPOT, ABOC

Luebbert Consulting & Training

Eye care can be more than vision care


99000’s

92000’s

Medical Codes vs Refractive Codes


How you document determines the billing level

Technician’s play a key role


Let’s see what your role is


Documentation is the key


Pretest Chairside documentation


It never happened

If it isn’t written down

XxxxxxxxXxxxxxxxxxxxxxxxxxxxxxx


SOAP

Parts of the examination


S = Subjective Data NOW PFSH and ROS

O = Objective NOW Physical Examination

A = Assessment Remains Assessment

P = Plan NOW Medical Decision Making & Management

Update from SOAP


Where do we start?


Subjective Data

HPI◦ History of Present Illness

PFSH◦ Past, Family, and Social History

We start at the beginning


‘What brings you here today?’

Chief Complaint


Determines what happens next

Is the chief complaint medically oriented?

Why is this important?

Refractive - 92000

Medical - 99000


Vision cloudy Feel itchy Teary Vision fluctuates Shadows Headaches Red

Examples of ‘medically oriented’


NOW…………. 99000 CODES

Medically oriented…..


DOCUMENT!!!!!!!!!

If you ask or observe


Location (where) Quality (sharp, dull, hazy) Severity (mild, severe, bothersome) Duration (constant, off & on) Timing ( mornings, mid-day) Context (driving, reading) Modifying Factors (bright light, close eyes) Associated Signs & Symptoms(itch,

headache)

History of Present Illness (HPI)


If you investigate and document 1 – 3 items◦ Brief

If you investigate and document 4+ items◦ Extended

HPI catagories

Location (where)Quality (sharp, dull, hazy)Severity (mild, severe, bothersome)DurationTimingContextModifying FactorsAssociated Signs & Symptoms


Allergies (environmental, drug) Cardiovascular (hypertension, stroke) Constitutional ( weight loss, fevers) Ears, Nose, Mouth, Throat (upper

respiratory) Endocrine (NID, ID, thyroid, hormonal) Eyes (GLC, AMD, Surgery) Gastrointestinal (ulcers, colitis) Genitourinary (STD)

Review of Systems (ROS)


Hematologic/Lymphatic (anemia, leukemia) Integumentary (psoriasis, eczema, rosacea) Musculo-skeletal(osteoarthritis,

fibromyalgia) Neurological (MS, epilepsy) Psychiatric (depression, panic disorders) Respiratory (cigarette smoker, asthma)

ROS


If you investigate and document 1 area◦ Problem Pertinent

If you investigate and document 2 – 9 areas◦ Extended

If you investigate and document◦ Complete (Can say all others are negative)

ROS


Past◦ Ocular – cataract, AMD, GLC, surgery◦ Medical – diabetes, hypertension

Family History◦ Ocular – cataract, AMD, GLC, surgery◦ Medical – diabetes, hypertension

Medication◦ OTC and pharmaceutical

Social◦ Smoking, alcohol, hobbies

Past, Family, and Social History(PFSH)


If you investigate and document 1 area◦ Pertinent

If you investigate and document 2 – 3 areas◦ Complete◦ Required

if new patient

PFSH


Billing level groundwork is laid

At this point,


Problem Focused Extended Problem Focused Detailed Comprehensive

Will this visit be….


ProblemFocused

ExpandedProblem Focused

Detailed Compre-hensive

HPI 1-3 elements

1 – 3 elements

4 or more elements

4 or more elements

ROS None 1 element 2 – 9 elements

10 or more elements

PFSH None None 1 element 2 or 3 elements


If you looked at it

DOCUMENT IT!!!!!

If the doctor looks at it

DOCUMENT IT!!!!!

Physical Examination


Be observant

The doctor may not follow the ‘traditional’ sequence

Document

If you are chairside assisting


Acuity Visual Fields (confrontation) Tonometry Ocular Motility (cover tests, EOM)

Eye Elements


Adnexae (lids, lashes, puncta, orbit) Conjunctiva (palpebral, bulbar) Anterior Chamber Pupil / Iris Cornea Anterior Chamber Crystalline lens Retina (macula, foveal reflex, a/v ratio) Cup/Disc

Eye Elements


Orientation to time, place, person General Constitution (mood)

Systemic Element


Determine if additional groundwork is laid

At this point……


1- 5 eye elements◦ Problem Focused

6 – 8 eye elements◦ Extended Problem Focused

9 – 11 eye elements◦ Detailed

Comprehensive 12 eye elements & 1 systemic element

Investigated and Documented


Problem Focused

Expanded Problem Focused

Detailed Comprehensive

1-5 elements

6-8 elements

9 – 11 elements

12 elements &

1 mental status


Are determined by the number of areas of the examination process investigated

Billing levels


What about the refraction?


May be a routine portion of the examination However Is not a medical test IS refractive (92000) Is to be separated from medical procedures

Refraction


Diagnosis & Management Options Data Complexity Risk

How do we get to the coding


Straight forward

Low complexity

Moderate complexity

High

Diagnosis & Management Options


The doctor determines

Levels◦ Minimum◦ Limited◦ Moderate◦ Extensive

Data Complexity


Presenting Problem Diagnostic Procedure Management Options

Minimal – Low – Moderate - High

Risk


Straight Forward

LowComplexit

y

Moderate Complexit

y

HighComplexit

y

Dx & Management Options

Minimal Limited Multiple Extensive

Data Complexity

Minimal Limited Moderate Extensive

Risk Minimal Low Moderate High

Decision Making


History Problem Focused



Compre-hensive

Exam Problem Focused



Compre-hensive

Decision Making

Straight-Forward

Straight-Forward

Low Complexit

y

Moderate Complexit

y

High Complexity

E&M Code

99201 99202 99203 99204 99205

New Patient


History Dr Need Not Be Present

Problem Focused

Ex Problem Focused


Exam Dr Need Not Be Present

Problem Focused

Ex ProblemFocused


Decision Making

Dr Need Not Be Present

Straight-Forward

Low Complexit

y

Moderate Complexit

y

High Complexity

E&M Code

99211 99212 99203 99214 99215

Established Patient


Lower coding Lower billing level

What if you did not document


Documentation Follow through

You play an important role


Leads to Higher levels of procedure levels Higher billing levels

Efficient Recording of Procedures


You can and do make a difference


Enjoy Nebraska Optometric Conference Experience

Jill J Luebbert, CPOT, [email protected]

mailto:[email protected]

jill j luebbert, cpot, aboc. luebbert consulting & training

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