Ophthalmology and Optometry Coding Alert

Positive reimbursement starts with effective communication, these experts say.

Are you maximizing your EMR’s ability to help you select ICD-10 codes? This is just one of the many areas where your ophthalmology practice can increase efficiency—and being more efficient can lead to more income. The following three expert tips can help you eliminate challenges and bring in more money going forward.

1. Intercommunication Is Key to Patient Satisfaction

Many ophthalmology practices report that their biggest practice challenge involves customers complaining about wait times. You can stem this issue with one simple tool—better communication. 

“It is our priority to make sure communication plays a major role in the process of a patient’s visit,” says Martha Tello BGS, COMT, of the Bascom Palmer Eye Institute at Plantation in Florida. Just like appointment representatives should inform patients of the approximate time a visit may take and remind them to bring pertinent information including a list of current medications, previous medical records and related tests results, the ophthalmologist should inform the checkout registration personnel about possible tests to be ordered for the next visit, she says.

This advice facilitates insurance approval of ancillary testing and preventing visit delays the next time the patient comes into the office. Everyone in the clinic should be aware that the process of a clinic visit takes time, and frequently, due to emergencies and unexpected circumstances, clinics may run behind. It is in these situations when visits and tests approvals are even more valuable, Tello says. “Yes, patients might wait, for any other reason, but they feel satisfied that we are attentive to their needs in every step of the process.”

2. Verify With Insurers Up Front

The best way to ensure that you collect for your visits is to confirm that your coding procedures and diagnosis codes are accurate and meet the insurer’s requirements. 

In some cases, authorization is required before you can perform a particular service—in these instances, make sure you have the correct CPT^® code for the planned procedure, then call the insurer and verify the coverage details. “Often, patients get authorization for a visit, but no authorization for diagnostic testing,” Tello says. “Therefore, it is wise for insurance verifiers to be alert and catch a lack of authorization prior to patients coming to see the physician and act accordingly.”

Keep in mind that insurers are all different, and you may even encounter different patient plans at the same insurer. “Most times, patients are not aware that visits require tests, and they arrive with authorization for the visit only,” Tello says. “Unfortunately, the insurance verifier might spend hours with the insurance company trying to obtain approval and this becomes even more complicated when the patient is an add-on, and clinics are running behind.”

3. Allow Your EMR to Keep You Efficient

Some practices continue to face challenges with ICD-10, which took effect in October. Tello’s practice has experienced smooth sailing for her diagnosis claims, thanks to a few simple proactive steps that your ophthalmology office still has time to enact if it hasn’t already.

“Our physicians, technicians, nurses, surgical coordinators and coding personnel had mandatory web-based education in an effort to be well prepared for the transition to this new coding system,” Tello says.

Proper training and education was vital for an easy transition to ICD-10, says Stephanie McMillan, MHA, COT and EMR super user at Bascom Palmer. “Fortunately, these new sets of medical codes are automatic in our EMR system. Our computer-based learning educated our clinicians in proper ICD-10 coding specifically including laterality and severity with each diagnosis.”  Therefore, a correct diagnosis brings the correct code without having memory play a role.

McMillan also reports that many of her practice’s ICD-10 diagnosis codes were deleted from the practice’s EMR system, which could have caused a problem without proper education beforehand. Consequently, they refer to training as a game changer in the success of ICD- 10 implementation.

If your EMR isn’t yet configured to help you find the right diagnosis codes for your visits, now is the time to speak with your vendor about setting up that feature.