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Watch Your Arsenal Before You Look for Optometry Coding Updates

For optometry coding professionals, tough times lie ahead if you do not tackle your coding errors. On an average for 2008, almost 43 percent of the quality data codes (QDCs) that practices submitted to CMS were ineligible for the PQRI bonus because physicians reported them improperly. Watch out for NPI, HCPCS code mistakes to keep your reimbursements flowing, and get the PQRI incentives that your practice deserves.

Optometry Coding Mistakes

Missing NPI: CMS notes that 97,131 of the QDC submissions were missing their national provider identifier (NPI). This happened rarely in the eye care measures; less than 1 percent the five measures optometrists could report was missing NPIs. Among the worst offenders in this category were claims for measure 112 (Screening mammography), which lacked an NPI in 3.5 percent of QDCs.

Wrong HCPCS code: A whopping 15.6 percent or 3 million claims of QDC submissions had incorrect HCPCS codes on them. One of the most common errors in this category occurred with measure 130 (Documentation and verification of current medications in the medical record). CMS noted that 74.6 percent of claims for this measure featured an incorrect HCPCS code. Also at a high risk of errors was measure 46 (Medication reconciliation: Reconciliation after discharge from an inpatient facility), with 69 percent of claims featuring an incorrect HCPCS code. Among the eye-care specific measures, 9.4 percent of claims for measure 14 (Dilated macular examination) featured the wrong HCPCS code.

Your optometry coding mistakes cost you your reimbursement as well as the PQRI bonus money. Apart from making changes to your coding habits, keep in mind that auditors also look for discrepancies in patient-age mismatches, as well as patient-gender mismatches. Pay attention to the basics and once in a while, get in touch with experts to clear your doubts regarding critical scenarios.

About the Author

We also provide medical billing and medical coding audio conferences with premier coding experts, CDs, tapes and transcripts of coding training information by specialty.

九州大学ディベートクラブ台湾訪問 (Kyushu University QDC in Taiwan)