for cataract post care, what is their initial date of treatment for billing

Full Answer

Is coding and billing for post-op cataract care difficult?

Comanagement and billing for post-op cataract care—especially for patients who receive presbyopia-correcting IOLs—can be problematic. Coding and billing for services rendered to postsurgical cataract patients continues to raise issues in many optometric offices.

When do I start billing for post op care?

If you start care at the end of week 1 after surgery, you would bill for 83/90 of the post op fee. Once you see the patient for the first visit, you are responsible for the balance of the 90 days of post op care and bill accordingly. Thank you Dr. Cheezum for your input. It was very helpful. Jacki

Should you establish a set price for cataract post-op care?

Establish a set price for cataract post-operative care. Why? Because Medicare and the likes of other insurance companies consider post-op work to be a maximum of 90 days and pay a certain amount for this procedure intended to cover you for ALL visits with this patient in the 90 days following the actual surgery.

When do you see the patient after a cataract surgery?

We see the patient anywhere from 1-3 weeks postop. The surgeon provides us with a transfer of care letter with the information that we need to bill. We bill the same cataract code as the surgeon, with a modifier -55.

How do you bill Post op care after cataract surgery?

Use the same surgical CPT procedure code used by the surgeon, but add the -55 modifier to signify that you are rendering the postoperative care. The number of units billed can vary by carrier, so be aware of your carriers requirements.

What is the post op period for cataract surgery?

The recovery time for cataract surgery is short. Any soreness and discomfort should disappear within a couple of days. However, depending on the nature and size of your cataracts, and your physiology and ability and heal, full recovery could take anything from four weeks to six weeks.

How do you bill a post op visit?

Post-operative visits should be reported with CPT code 99024 when the visit is furnished on the same day as an unrelated E/M service (billed with modifier 24).

How do you bill for post op care only?

In those cases where the postoperative care is "split" between physicians, the billing for the postoperative care should be reported as follows: Report the date of service using the date of the surgical procedure. Report the procedure code for the surgical procedure, followed by modifier 55.

Can you bill for a refraction after cataract surgery?

Yes. Under Medicare law (Social Security Act, 1861(s)(8)), beneficiaries are covered for post-cataract eyeglasses following cataract surgery with implantation of an IOL. However, Medicare does not pay for the refraction to prescribe those eyeglasses.

What is the global period for 66984?

Modifier 79 For example, if a patient has cataract surgery with an IOL in the right eye (66984-RT), the global period is 90 days, so any other surgery done on this patient's eyes in the next 90 days needs a modifier.

What is included in the post op period?

Immediate postoperative care, including dictating operative notes, talking with the family and other physicians or other qualified health care professionals. Writing orders. Evaluating the patient in the postanesthesia recovery area. Typical postoperative follow-up care.

Is post op day one the day of surgery?

Postoperative day one is the real start of your recovery. On the first morning after surgery, provided you are stable, most of the tubes and monitoring lines are removed and you are transferred to the post-op Cardiac Surgery Unit where you will remain for the rest of your hospitalization.

When does the postoperative period end Iacuc?

Post Operative Period During the post-operative period (until the sutures are removed, surgical wounds are adequately healed, or 10-14 days) a minimum of daily-recorded observations is required. All surgery related medications administered (e.g., analgesia) must be documented.

What is assumed care date?

At A GlanceName:Assumed or Relinquished Care DateType:Data ElementDefinition:Date post-operative care was assumed by another provider, or date provider ceased post-operative care.Version:005010Data Element Reference Number:12512 more rows

What procedures have a 10 day global period?

Medicare defines the global period as that period of time during which a physician may not bill for related office visits. The global period may be 90, 10, or 0 days. According to Medicare, a major surgery has a global period of 90 days, and a minor surgery has a global period of either 10 or 0 days.

What is modifier 59 used for?

Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.

How long does cataract surgery last?

The Centers for Medicare and Medicaid Services (CMS) has determined that the postoperative global period following cataract surgery is 90 days. Also, the CMS-approved reimbursement for the postoperative portion of the cataract surgery is 20%.

When did CMS clarify payment rules for presbyopia correcting intraocular lenses?

In May 2005, CMS clarified payment rules for those patients who choose presbyopia-correcting intraocular lenses. This allowed providers to balance bill the patient for non-covered care related to the presbyopic portion of the pre- and postoperative care provided. Patients who choose these lenses are responsible for the additional expenses for services that exceed the charges for conventional IOLs.

What does the -55 modifier mean?

Use the same surgical CPT procedure code used by the surgeon, but add the -55 modifier to signify that you are rendering the postoperative care.

How long after transfer of care can you bill?

You should bill for all of the days following the transfer of care, but you cannot submit the claim until youve evaluated the patient at least once. The ophthalmic surgeon must be listed as the referring physician. The diagnostic code you use needs to be identical to that used by the surgeon.

Do Medicare Part B insurance companies follow the same guidelines?

Take note: These guidelines refer only to Medicare Part B. Although many insurance carriers follow the same guidelines, some do not. Make certain you contact your local carriers prior to submitting claims to ensure that youre compliant with their guidelines and policies.

What is the CPT code for post-operative care?

Once the co-managing provider has provided postoperative care, he or she submits a claim form citing the appropriate CPT code and co-management modifier (-55), which indicates post-operative management only, as well as the date he or she assumed the patient’s postoperative care.

How is post operative care divided?

In cases where more than one provider furnishes post-operative services, the payment will be divided between the providers based on the number of days for which each provider is responsible for furnishing post-operative care.

Why aren't the correct modifiers appended on the second postoperative claim?

Since the cataract post-op care was performed within the global period of the first postoperative claim, the office billers were not appending the correct modifier on the second postoperative claim to ensure both claims were paid correctly.

What is MBC billing?

Catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.

What is the modifier for a surgical procedure?

This modifier is required to identify the surgical procedure in a co-management scenario.

What is patient preference?

Patient preference or the patient experiences another illness or complication that requires intervention by another provider

Can you co-manage a cataract surgery?

Your co-management claim will be denied if the surgeon has not filed their claim, or if they filed without using the correct modifier indicating surgical care only. Moreover, to avoid delayed payments good communication with the surgeon’s office should be maintained.

How long after cataract surgery can you shower?

After you return home, you should be careful not to get soap and water directly into your eye for the period of time recommended by your ophthalmologist. Although you should be able to perform normal activities like showering within a day after this outpatient surgery, you may need to protect your eye while you bathe. You should also avoid many hair products, perfumes, face washes, lotions, and makeup for a few days while your eye heals. You may wear special eyeglasses for a few days after surgery to prevent you from poking, rubbing, or scratching your eye. Itching and discomfort are common for a few days after the procedure, but it is important to avoid touching your eye during this time.

How long does it take to recover from cataract surgery?

( Learn More) Since your eye takes time to adjust to the artificial lens, recovery will likely take from several weeks to two months.

How to treat eye pain?

You may receive medicated eye drops to treat the pain. You should also receive a pair of prescription sunglasses to protect your eyes from the glare of the sun or lights, and it is important to wear these for the length of time recommended by your ophthalmologist. To ensure the safety of your eyes overnight, you may also receive an eye patch or a protective visor to wear to bed so your eye is not hit or poked in your sleep.

How long after eye surgery can you use eye drops?

You may be using medicated eye drops for several days after the procedure, which may require cleaning around the outside of your eye. Follow your eye doctor’s instructions for this very closely to avoid getting anything, including sterile water, in your eye.

What is the best treatment for a bloodshot eye?

Blurry or double vision. A red or bloodshot eye. You may receive medicated eye drops to treat the pain. You should also receive a pair of prescription sunglasses to protect your eyes from the glare of the sun or lights, and it is important to wear these for the length of time recommended by your ophthalmologist.

What are the complications of a retinal ophthalmectomy?

It is important to closely follow your ophthalmologist’s guidelines for recovery, so you are at less risk of developing complications from the procedure, like inflammation, infection, swelling in the retina, detached retina or lens, pain, and vision loss. Your ophthalmologist will give you a more detailed schedule of recovery time and expectations, ...

Can you go home after cataract surgery?

Cataract surgery is most often an outpatient procedure, so you will be able to go home the same day your cataract is removed. This means that most of the recovery process will be at home, with some follow-up visits to your ophthalmologist to make sure your eye is healing properly. It is important to closely follow your ophthalmologist’s guidelines for recovery, so you are at less risk of developing complications from the procedure, like inflammation, infection, swelling in the retina, detached retina or lens, pain, and vision loss.

Why is cataract surgery co-management important?

Co-management for cataract surgery care can also facilitate on-the-spot referrals and more efficient patient care. In this mode of practice, patients receive enhanced benefits and services because they get easier access to high-quality eye care — and, of course, when patients, win, doctors win, too.

When can you bill for co-management?

Routinely billing for co-management on the date care was assumed. You can’t bill for co-management until at least one service has been provided to the patient. However, you don’t have to wait until the end of the global period to submit the claim.

What are the common co-management billing errors?

Look out for these five common co-management billing errors that lead to denials: 1. Using the patient’s post-op visit date as the date of service on the claim form, when it should actually be the surgery date. The claims for surgical care and post-op care must both list the same surgical date of service. 2. Not including the dates of assuming and ...

Why do optometrists do eye care?

The optometrist gets to see a greater variety of patients and conditions in addition to the routine eye care he or she may be used to providing, which helps to break the monotony of day to day care and offers enhanced opportunities for professional advancement , as well as the opportunity to connect professionally with a new set of partners .

Can you co-manage cataract surgery?

Co-management in a cataract surgery setting, however, can present a new set of issues that all parties involved need to work through, and special attention needs to be paid to billing. You, your office, and in particular your billing staff, should be aware of these possible billing challenges before you decide to pursue this type of care arrangement.

Is post op visit the same as surgery date?

Using the patient’s post-op visit date as the date of service on the claim form, when it should actually be the surgery date. The claims for surgical care and post-op care must both list the same surgical date of service.

Is co-management a good option for cataract surgery?

Co-managing as a type of collaborative care for cataract surgery can be beneficial for all parties involved:

What does cataract attestation mean?

When one or more concomitant ocular diseases are present that potentially affect visual function (e.g., macular degeneration or diabetic retinopathy), the attestation should indicate that cataract is believed to be significantly contributing to the patient’s visual impairment.

What is an appropriate preoperative ophthalmologic evaluation?

An appropriate preoperative ophthalmologic evaluation, which generally includes a comprehensive ophthalmologic exam (or its equivalent components occurring over a series of visits). Certain examination components may be appropriately excluded based on the specific condition and/or urgency of surgical intervention.

Why use capsular tension rings?

Use of capsular tension rings or segments to allow secure placement of an intraocular lens (e.g., in the presence of pre-existing zonular weakness); and/or need for creation of a primary posterior capsulorhexis.

Can you use CPT in Medicare?

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials of CMS internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

What is a reasonable expectation of lens surgery?

A statement that the patient desires surgical correction, that the risks, benefits, and alternatives have been explained, and that a reasonable expectation exists that lens surgery will significantly improve both the visual and functional status of the patient.

What is an attestation supported by documented symptoms and physical findings in the medical record?

An attestation supported by documented symptoms and physical findings in the medical record indicating that the patient's impairment of visual function is believed not to be correctable with a tolerable change in glasses or contact lenses.

Why do contractors specify bill types?

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service . Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

What are the expectations of cataract surgery?

If a patient enters into surgery expecting an improvement in vision after a measured recovery, a significant amount of work instilling eye drops, absolute presbyopia and some amount of residual refractive error, that patient will likely be pleased at every step . If you have the misfortune of caring for a patient who is expecting a perfect outcome, you will have to spend some time working through their unrealistic expectations. Any experienced surgery center will work hard to ensure that all patients have an accurate understanding of what the cataract surgery process will and will not deliver.

How long does it take for edema to clear after cataract surgery?

Corneal edema. This complication is common and often self-resolving in the first few days or weeks after cataract surgery, but will dramatically affect vision until it clears—usually causing the patient much anxiety. As blur may arise from several factors, it is crucial to rule out a retinal detachment even in cases of evident corneal edema. Immediate post-op corneal edema will come from one of three sources, each treated slightly differently. Examine all layers of the cornea carefully; edema can manifest as microcysts or even bullae at the epithelium, as thickening of the stroma or as folds in the endothelium.

What is grade 1+ in the anterior chamber?

This illustration shows grade 1+ cells in the anterior chamber, a mild and normal amount of inflammtion in the first week after cataract surgery.

How long after a dilated fundus is a final exam?

The one-month exam. Typically, the patient will have one final exam three to six weeks after surgery. This one must include a dilated fundus exam to confirm the patient is well-healed and stable, and also a final postoperative refraction and prescription.

What is the purpose of a one day postoperative exam?

Use the first postoperative exam to ensure that the surgery was carried out well, to verify that the patient understands their responsibilities and to answer their immediate post-op questions and concerns.

Where are cataract fragments found?

They are most commonly found in the inferior anterior chamber angle or hidden in the capsule equator behind the iris. 9 Any unusual level of cells in the anterior chamber should prompt a gonioscopic search of the angle, but a fragment behind the iris will be hard to find.

When to rotate toric IOL?

Any suspicion of a significant rotation should precipitate a return to the surgery center, and quickly; the best time to rotate a toric IOL back into place is within the first few weeks, before the capsule has a chance to fibrose down around the lens.

The Stages of Post-Cataract Surgery Recovery

Recommendations For Care After Cataract Surgery

• In the days and weeks after your surgery, it is recommended that you: 1. Use prescription eye drops as detailed by your ophthalmologist. 2. Follow all the recommendations of your ophthalmologist and/or eye surgeon. 3. Rest and relax for two to three days. 4. Use your eye shield every night for at least one week. 5. Wear the eye shield while showeri...

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