Optometry Coding & Billing Alert

Published on Tue Oct 04, 2005 PDF

If your E/M code distribution looks much different from Medicare's data, you may attract audit attention

A thorough internal audit should include a look at your code use. Medicare keeps track of how often optometrists report certain E/M codes--and if you vary from the pattern too much, they may want to know why.

Here's how optometrists used the office visit E/M codes in calendar year 2004:

In all, Medicare paid optometrists for 10,064 office visits in 2004. Look at the allowed services for each as a percentage of the total and compare with your own data:

Although the rates might vary in different locations, this data would lead Medicare to expect about 5 percent of your E/M visits to be 99203 and 42 percent 99213, for example.

Do this: Check with your specialty society or association for more complete data. Download national billing statistics from Medicare at www.cms.hhs.gov/statistics/feeforservice/default.asp.