Clinical Scorecard: Coding for AMD

At a Glance

Key Highlights

• Proper ICD-10 coding is essential for AMD documentation.
• Distinct medical necessity must be established for certain imaging codes.
• OCT and OCT-A are generally not billable together on the same day.
• Documentation of test orders is imperative for ERG codes.
• Illustrations of findings should accompany extended ophthalmoscopy submissions.

Guideline-Based Recommendations

Diagnosis

• Determine type, severity, and laterality of AMD for accurate ICD-10 coding.

Management

• Use appropriate modifiers when billing for imaging codes.

Monitoring & Follow-up

• Check patient’s plan and Local Coverage Determinations for imaging coverage.

Risks

• Improper coding can lead to denied claims and financial losses.

Patient & Prescribing Data

Individuals diagnosed with AMD requiring imaging and monitoring.

Robust documentation and adherence to billing guidelines are crucial.

Clinical Best Practices

• Always include a signed interpretation/report with imaging findings.
• Utilize hand-drawn or digital illustrations for extended ophthalmoscopy submissions.
• Stay informed on billing guidelines to ensure compliance and optimal patient care.

References

• Optometry Coding and Billing Guidelines