coding strategy

OSD Opportunity Missed …

in the blink of an eye

JOHN RUMPAKIS, O.D., M.B.A.

Ocular Surface Disease (OSD) is a broadly defined category of clinical care that O.D.s are deeply involved in. When we think of OSD we typically think of dry eye, but I, for one, think of all the comobidities of this category. We see patients with ocular allergy, contact lens (CL)-related dry eye, meibomian gland disorders, aqueous deficient and lipid deficient dry eye, recurrent corneal erosion and many corneal dystrophies. Patients rarely present with just one of these, but more often, with at least two or more areas of concern. Being the first line of care, opportunities for clinical care are abundant for O.D.s. Unfortunately, frequent OSD coding mistakes are also abundant.

Here are some essentials for every OSD patient encounter.

1. “Triage” the patient.

Have your receptionist ascertain the exact reason for the patient's visit. This way, you can establish both the amount of time needed for the patient, as well as who may be responsible for the visit: the patient, the refractive or medical carrier.

2. Obtain all insurance information.

Capture all insurance data, and verify. That means both refractive and medical insurance. Don't assume anything is the same from visit to visit.

3. Accurately record the chief complaint.

Remember that the determination of coverage by a medical carrier is dependent on the visit's purpose, not on your diagnosis.

4. Perform a related exam.

Carry out an exam commensurate with the presenting symptoms and conditions. Not every exam is a comprehensive exam, nor is every CL problem a “free” CL follow-up exam. Appropriate use of the 920XX and 992XX codes is essential. If the level of the visit is not appropriate for the level of the presenting problem, you'll likely have trouble defending yourself in an audit.

5. Establish/record medical necessity.

Do this for everything: follow-up visits, special ophthalmic tests and referrals to other providers.

6. Accurately establish/record all diagnoses.

Correctly recognize and record all diagnoses found. Remember: The ICD-9 requires only fifth-digit specificity. However, with the upcoming transition to the ICD-10, we must hone our skills for seven-character specificity.

7. Code based on the record.

Code based upon just what you have recorded. Do not over or under code. If done properly and in accordance with the CPT definitions, you will have used both 920XX and 992XX codes.

Why OSD vs. other conditions

Many times, we fail to recognize that in OSD comorbid conditions occur year round. Differential diagnosis is complicated, yet vital to prescribing the correct treatment for each condition. Also, we tend to inappropriately lump CL problems into a refractive carrier's CL benefit structure; remember, when a patient presents with a “contact lens problem,” the CL is not having a problem, the eye is, and you should get paid to diagnose and treat it.

OSD represents one of the most prevalent opportunities for O.D.s. If you don't recognize this, the opportunity will pass you in the blink of an eye. OM

DR. RUMPAKIS IS PRESIDENT AND CEO OF PRMI, A CONSULTING FIRM FOR THE HEALTHCARE INDUSTRY. A PROLIFIC LECTURER, HE IS ALSO THE DEVELOPER OF A CLOUD-BASED CPT/ICD DATA & INFORMATON SERVICE. SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.