Ophthalmology and Optometry Coding Alert

If you are worried about claim denials, up to your ears in last-minute precertification requests, or not sure if your superbills are being translated appropriately to the claim form, we have a tip for you from Leslie R. Jebson, manager of specialty clinics operations at the University of Missouri Health Sciences Center in Columbia, MO. The solution is to have a technician-coder team review the superbill before it goes to patient accounts.

We put an ophthalmology technician and a coder at a desk in the clinic, says Jebson. After the ophthalmologist does the coding on the superbill, he hands the form to the coder. The coder works the form before it goes to patient accounts to be billed out, he explains. The coder makes sure the correct codes and modifiers are being used, Jebson adds. The ophthalmology technician is the resource for medical terminology for coding.

This procedure has been in place for only a few months, but it is already paying for itself, says Jebson. There are fewer denials, he notes. We really want to get it right the first time. There is also an incentive: if the coder catches problems before they go out, she gets a commission, explains Jebson. This same team also does the precertifications for the seven-ophthalmologist clinic; the technician also does the telephone triage. Its not worth an ophthalmologists time to do the precerts, he notes. But you do need someone who can talk the language with the insurance company. With the coder and the technician there, the process is smoothed, he reports.

What if you have a smaller practice, and not Jebsons seven ophthalmologists? Use just one person, but have him or her wear two hats, he recommends. Take an ophthalmology technician and send him or her to some coding courses. Then this person can do both jobs. The key is to review the form before it goes out.