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Topic: Improve ophthalmology coding at your ASC (part one of two)

Ambulatory Surgery Reimbursement Update, May 13, 2008

Even though ASCs are still watching and waiting for claims to make their way through the new Medicare payment system, it’s not too early to look for ways to improve coding and ensure that your center is billing for services appropriately. Due to their complex nature, ophthalmology procedures are a good place to start this review.

“ASCs make few mistakes on Medicare claims, but those mistakes that ASCs do make generally occur because the coder or biller reads the title of the operative report but doesn’t bother to read the narrative below,” says Kevin J. Corcoran, COE, CPC, FNAO, president of Corcoran Consulting Group in San Bernardino, CA.

For example, the title of an ophthalmology operative report might seem reasonably straightforward but can actually be misleading. It might state that the procedure is a cataract surgery with intraocular lens (IOL), whereas the actual narrative only describes cataract extraction, Corcoran says. In cases in which the title and narrative do not agree, coders should always code according to the narrative, he says.

Treatment of wet age-related macular degeneration is particularly vulnerable to coding errors because of the advent of new treatments and drugs.

Physicians may administer the drugs via injection in physicians’ offices or ASCs. In the past, ASCs may have billed for these drugs separately; however, new rules now apply. CMS’ instructions in the ASC final rule state that not all drugs are paid separately and some are included in the facility fee.

“This is one illustration of how things change due to the new rules, and people are simply not aware of them yet,” says Corcoran, “and this can come as a big surprise.”

Editor’s note: This topic is from the May 2008 issue of Ambulatory Surgery Coding & Reimbursement Insider.

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