Stay current on the medicolegal aspects of ophthalmic practice with monthly updates on Medicare’s local coverage determinations.  The directory includes definitions of the most common Current Procedural Terminology (CPT) codes used by optometrists and ophthalmologists and their current allowable fees.  In addition, the directory provides the following relevant information for each CPT code:
  • Clinical indications
  • Covered diagnoses
  • Documentation requirements
  • Coding guidelines
  • Utilization guidelines
For most optometrists and ophthalmologists, elderly people represent the largest group of patients that require medical eye care.  Because most of these patients are covered by Medicare insurance, it is critical that you and your staff understand all of Medicare’s policies and procedures.
Medicare coverage is limited to services that are reasonable and medically necessary for the diagnosis or treatment of an illness or injury.  National coverage determinations (NCDs) are evidence-based policy statements that are published by Medicare in the Federal Register.  They identify the clinical circumstances and settings under which particular services will be considered by Medicare.  In effect, they describe and define medical necessity for patients covered by Medicare.
In the absence of a national coverage policy, a service may be covered at the discretion of the local Medicare carrier based on a local coverage determination (LCD).  Like national coverage determinations, they identify the clinical circumstances and settings under which particular services are reasonable and medically necessary.
Accessing the CPT Code Directory can help to increase reimbursements by empowering the doctor and the staff with more knowledge.  For example, the information in the Directory shows when specific procedure codes can be reported with specific diagnosis codes.Also, the various entries display Medicare’s allowable fee for each eye-related CPT code in your region of the country.  The fee schedule is updated annually, and it can be vital in determining if the doctor’s fees are set appropriately.
By utilizing the information in the CPT Code Directory to support clinical coding and documentation, your practice will realize the following benefits:
  • Increased reimbursements
  • Increased protection against audits
  • Reduced risk of billing and coding errors
  • Reduced risk of recoupment