How ICD-10 Changes Optometry Coding and Billing

by Applied Medical Systems

  The ICD-10 transition is coming on October 1st! The time will fly by as you try to prepare your practice for this major change in the medical industry. Is your optometry practice prepared? Read up on our list of changes regarding optometry coding and billing as the ICD-10 transition comes.

What to Expect for Optometry Coding

  • If you have an EHR, they should do most of the heavy lifting. Transitioning from the existing ICD-9 system will be difficult on a technical level. Your Electronic Health Records system should guide you as a user to the correct diagnosis. The correct diagnosis under ICD-10 will need to be specific and also billable. Most optometry and ophthalmology practices are going to be looking to their EHR to make the transition easier.
  • Most codes have RT and LT built in. Fewer modifiers are needed, but you will need to use at least two codes to fully code a patient’s condition.
  • Glaucoma staging codes are gone. These are now built into the main code.
  • Diabetes mellitus (DM) codes are now mostly combination codes. These combinations include the type of diabetes, the patient’s complications and the body system that their disease is affecting. Subcategories will specify the types of complications (ex. ophthalmic complications) and then the exact issue. Do not forget to add your insulin use code.

What to Expect for Optometry Billing

  • Again, your EHR should do most of the heavy lifting. For billing purposes, make sure your documentation allows for the greater specificity found in ICD-10 codes.
  • Make sure your EHR and clearinghouse have done end-to-end testing. End-to-end testing will involve the submission of ICD-10 code test claims to Medicare. The optometry practice will also need to receive a Remittance Advice (RA) explaining the decision on the test claims. All of this is done to guarantee that the provider can effectively submit ICD-10 codes using an EHR and clearinghouse.
  • Make sure your staff has had at least some basic ICD-10 training. We recommend having at least two trained staff members that have a basic understanding of ICD-10.
  • Be ready for an increase in denials. As commercial carriers work out how they will interpret the new codes, denials will be more common. However, you may have some protection with the support of the AMA (American Medical Association). Additionally, outsourcing medical billing can help your practice with denial management.
  • Make sure your billing staff is ready to review and work these denials. It is also important for your billing staff to communicate their findings to doctors and coding staff so as to avoid repeated denials for the same error.

Preparing for the Transition

Even with advice and tips on how to prepare, the transition is going to have major effects on every optometry practice. At Applied Medical Systems, we want to help your practice as you embark on this change. We can provide optometry billing and coding services as well as medical practice management services. Contact us at our Durham, NC office. We serve practices in the Triangle area.