A: The answers to several top reader questions regarding coding, including those that address audits, insurance plans and a discussion of dilation and widefield imaging, can be found in recent “Coding Strategy” columns. Here, I provide summaries of each column. (For a more detailed explanation, follow provided links to the original columns.)

Q: Can you share tips on how to stay current with vision plans?

A: Review updates to vision plan and medical insurance manuals annually. I recommend at the beginning of each year. While insurance companies provide a “quick list” of updates, consider reading the manual thoroughly, if you haven’t done so in more than a year.

Two areas that have seen recent changes and are, therefore, worth paying attention to, are diabetic eye care and coordination of benefits. To determine diabetic care, search “diabetic eye care services” on the plan website. Look for the steps needed to determine covered services. Investigate coverage for both screening services (such as imaging and OCT) for patients who have a diabetes diagnosis and medical testing for patients who have a diabetic diagnosis and who have been found to have diabetic retinopathy.

What coordination of benefits includes is the ability to bill the patient’s medical plan for an office visit and procedures, when medically necessary, as well as refraction. This benefit will depend on specific plan details of coverage, which can be found on the vision plan website. Read more at bit.ly/2020JanCoding .

Q: What are the main areas of concern during an audit?

A: The top five problem areas are:

1. Failing to participate in provider education to stay up to date with compliance best practices.
2. Failing to routinely (yearly) perform self-audits that allow problems/errors to be discovered internally; and then providing internal, written documentation to show how problems are being found and addressed.
3. Failing to document patient’s chief complaint (detailed explanation of the visual complaint or problem).
4. Failing to document history of patient’s present illness that expands on the chief complaint.
5. Failing to document detailed communication with other providers.

Many audit problems can be prevented by performing a self-audit. The CMS website provides this resource to help (go.cms.gov/2WNVXtE ). Continue reading at bit.ly/2019DecCoding .

Q: Can I eliminate dilation if I perform widefield retinal imaging?

A: Before you consider eliminating dilation, research the guidelines to ensure you’re making the right decision. Start with state laws. Every state is different, and some have strict requirements regarding dilation and what can and cannot substitute it.

Next, review the definitions in CPT from the AMA and documentation guidelines. The 92000 codes, by definition, typically do not require dilation. However, they leave it to the doctor’s discretion. The 99000 codes may specifically mention dilation, depending on the level of the code. Make any decision based on what is medically necessary.

Finally, check each vision and medical plan to see what is listed as specific requirements, and be certain you are meeting the requirements. For more on this topic, see bit.ly/2020SeptCoding . OM

DR. JASPER practices in West Palm Beach, Fla. She is an American Academy of Optometry fellow and is chief optometric editor of Optometric Management. Email her at april.jasper@pentavisionmedia.com.