Know more about Coding and Billing Guidelines of Medicare for Eye-care

1. Medicare for Eye-care: Coding and Billing Guidelines
Presenter
Jeffrey Restuccio
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Understand in Details about Coding and Billing Guidelines for Medicare (Eye-care)
A lot of clinics are unaware of uncertainty that crops up with Medical guidelines. Actually,
Medicare carriers differ with States and what one carrier can think acceptable may be
denied by the other.

2. Jeffrey Restuccio, CPC, CPC-H 2
Medicare Overview
• The Basics
• Updates
• Tips on working with Medicare
• Multiple Jurisdictions
• Understand carrier-specific rules
• A (few) common procedures
• Co-Management
• Office visits (both E & M and 920xx codes)
• How to appeal denied claims
• Preparing for ICD-10

3. EyeCodingForum.com 3
Ranking of Guidelines (CPT Concepts)
Vision PlansMedicaid Guidelines
If Medicare guidelines disagree with AMA CPT guidelines who do you go with?
State Regulations
State Boards (Optometry / Ophthalmology)
Private Payor Guidelines
Medicare Guidelines
General CPT Concepts – AMA Guidelines

4. Medicare Guidelines
• Well over 1400 pages.
• Very detailed payment and documentation guidelines.
• Over 74% of private carriers follow Medicare guidelines.
• Most guidelines are local and not national for Eyecare.
• Medicare and the OIG will audit you.
• Never pays for refraction or glasses.
• Medicare Concepts:
– “Incident To” Services
– Local Coverage Determinations
– 1997 Exam Guidelines
EyeCodingForum.com 4

5. Carrier Tips and Tricks
• When calling your carrier always get the person’s name and
email address if possible.
• Chat them up and compliment them on how hard they work.
Be nice even if you are frustrated with them.
• When you ask them what modifier to use they will say, “we
cannot tell you how to code.”
• Always work to get a carrier representative for your top
carriers (Medicare, Medicaid, Blue Cross).
• Always get any unique instructions in writing. Ask for their E-
mail address and send them an overview of the discussion
and have them reply.

6. To see the complete presentation check the
below link:
http://www.audioeducator.com/ophthalmology/medicare-eye-care-coding-biling-
09-10-2014.html