nursing home coding

1

Nursing Home CodingNursing Home Coding1.1. If using E&M coding, make sure your If using E&M coding, make sure your

documentation justifies your 99307, 99308, or documentation justifies your 99307, 99308, or 99309 claim. 99309 claim.

2.2. Don’t let your documentation look “cookie-Don’t let your documentation look “cookie-cutter”. If all your documentation looks alike, it cutter”. If all your documentation looks alike, it raises question of authenticity.raises question of authenticity.

3.3. 3. The AOA says an OD can use the 92xxx exam 3. The AOA says an OD can use the 92xxx exam codes when making nursing home visits, using codes when making nursing home visits, using the place of service codes of 31 (skilled nursing the place of service codes of 31 (skilled nursing facility) or, more likely, 32 (nursing facility).facility) or, more likely, 32 (nursing facility).

22

Evaluation and Management Evaluation and Management CodingCoding

• There are three Key ComponentsThere are three Key Components– HistoryHistory– ExaminationExamination– Decision MakingDecision Making

99000 Evaluation and Management Codes

33

Chief Complaint A brief explanation of why patient is in the office.

Examples of medically necessary: Change in vision, poor vision, blurred vision Eye pain Evaluation of:

cataracts macular degeneration glaucoma

Examples of not medically necessary Routine exam Checkup No complaint Need new glasses

Evaluation of progression of

Loss of Vision

44

55

66

77

Dx: Cataract – mngmnt options

•Monitor; RTC 12 mo.

•Advise regarding reading & lighting

•Rx stronger reading addition due to cataract

•Discuss possible Cat Surgery w/ patient

•Recommend for Cat Surgery consult

Dx: AMD – mngmt options

•Montior: RTC 6 mo

•Rx & Instruct Re: Amsler grid

•Rx AREDS treatment

•Order Retinal photos to determine progression &/or need for consult

•Order OCT to determine progression &/or need for consult

Note: change in spectacle Rx is considered “none-covered” by this carrier, and thus is not a valid management option.

88

PRESENTING PROBLEM:

Minimal: Dry eye; old PVD; chronic blepharitis; vitreous floaters

Low: Cataract; two minimal (above)

Moderate: One chronic with mild progression: dry AMD; Two Chronic but stable: AMD and cataract

High: RD; vascular occlusion; field loss; TIA; wet AMD

99

•Data Complexity will almost always be minimal for ODs as described in the E&M Guidelines.

•If you feel you deserve any points for data complexity, it must be thoroughly documented in the patient record

1010

1111

1212

Final Code must beFinal Code must beReasonable and NecessaryReasonable and Necessary

ConsideringConsidering• HistoryHistory• Presenting ProblemPresenting Problem• Clinical findingsClinical findings

1313

92000 Comprehensive and 92000 Comprehensive and Intermediate CodingIntermediate Coding

• There are three Key ComponentsThere are three Key Components– HistoryHistory– ExaminationExamination– Decision MakingDecision Making

1414

Chief Complaint A brief explanation of why patient is in the office.

Examples of medically necessary: Change in vision, poor vision, blurred vision Eye pain Evaluation of:

cataracts macular degeneration glaucoma

Examples of not medically necessary Routine exam Checkup No complaint Need new glasses

Evaluation of progression of

Loss of Vision

1515

1616

1717

1818

1919

2020

Final Code must beFinal Code must beReasonable and NecessaryReasonable and Necessary

ConsideringConsidering• HistoryHistory• Presenting ProblemPresenting Problem• Clinical findingsClinical findings