#18: Avoiding Coding and Billing Disasters

[Paul Farkas]

Point of information...

ODwire.org Radio/ Podcast hopes to have Dr Richard Hom interviewed shortly. The interest in having a billing and coding expert share information speaks for itself.

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[Neil Speer]

"Order fundus photography" is now "order fundus imaging with associated interpretation and report for documentation of medical condition and future comparison" - similar change for anterior photography.

Would it be acceptable to print the above order out on a small piece of paper and physically attach it to the record rather than hand write it out (I still use paper records)?

 

[Steven Nelson]

Would it be acceptable to print the above order out on a small piece of paper and physically attach it to the record rather than hand write it out (I still use paper records)?

Printed or not, it doesn't matter. What needs to be there is somewhere in the plan it needs to reflect that you ordered photos and why and there needs to be attached somewhere a separate interpretation and report of the photos. Somewhere in that report needs to have comparative data. Whether it's printed or hand-written really doesn't matter from an audit perspective.

My personal take, and personal take is ALL this is, is that the more professional and polished it looks, the better you look to anyone looking at your stuff. That's true whether it's an auditor, a patient, another OD or an OMD you're referring to. That may very well be my OWN optometric insecurity complex coming out, but that's how I approach things like this.

 

[Neil Speer]

Printed or not, it doesn't matter. What needs to be there is somewhere in the plan it needs to reflect that you ordered photos and why and there needs to be attached somewhere a separate interpretation and report of the photos. Somewhere in that report needs to have comparative data. Whether it's printed or hand-written really doesn't matter from an audit perspective.

My personal take, and personal take is ALL this is, is that the more professional and polished it looks, the better you look to anyone looking at your stuff. That's true whether it's an auditor, a patient, another OD or an OMD you're referring to. That may very well be my OWN optometric insecurity complex coming out, but that's how I approach things like this.

My digital camera software has a place for interpretation and comparative data for each image, so, I'm assuming that it's sufficient to record findings within the software, not the written paper record.

One more important question:
If I see a new patient, obtain a digital retinal photo during pretest, and identify an abnormality (say, diabetic retinopathy) once the image is reviewed with the patient (during the initial visit), is it OK to bill the insurance company for the photo, despite the fact that the patient was not resheduled to come back in on another day for a photo of the pathology? In other words, can a "screening" retinal photo become a billable photo to document pathology?

 

[Richard Hom]

My digital camera software has a place for interpretation and comparative data for each image, so, I'm assuming that it's sufficient to record findings within the software, not the written paper record.

One more important question:
If I see a new patient, obtain a digital retinal photo during pretest, and identify an abnormality (say, diabetic retinopathy) once the image is reviewed with the patient (during the initial visit), is it OK to bill the insurance company for the photo, despite the fact that the patient was not resheduled to come back in on another day for a photo of the pathology? In other words, can a "screening" retinal photo become a billable photo to document pathology?

The difference between an "ordered" photograph pursuant to a retinal eye examination and a condition must be contrasted with a "screening" photograph that is serendipitous in circumstance. The former is likely to be coverable and the latter is questionable.

 

[Richard Pagan]

One more important question:
If I see a new patient, obtain a digital retinal photo during pretest, and identify an abnormality (say, diabetic retinopathy) once the image is reviewed with the patient (during the initial visit), is it OK to bill the insurance company for the photo, despite the fact that the patient was not resheduled to come back in on another day for a photo of the pathology? In other words, can a "screening" retinal photo become a billable photo to document pathology?

supposedly there are some exceptions but I'd say absolutely not, under any circumstance. Had you looked first and then talked with the pt and said I'd like to take photo (an order) of something that's in your eye, then you could bill it, but even then only if its a valid concern for which the photo can help care for the pt.

 

[Eric Newberry]

supposedly there are some exceptions but I'd say absolutely not, under any circumstance. Had you looked first and then talked with the pt and said I'd like to take photo (an order) of something that's in your eye, then you could bill it, but even then only if its a valid concern for which the photo can help care for the pt.

I definitely agree with Richard, but how does an outsider (i.e. auditor) know what came first. The screening photo or the ordered photo?

 

[Richard Hom]

I definitely agree with Richard, but how does an outsider (i.e. auditor) know what came first. The screening photo or the ordered photo?

Probably it is difficult to discern whether the photography was subsequent to a retinal examination. However, many EHR's time stamp various points in an examination and if a situation were to arise it is possible to tell whether the retinal examination was done before the photograph or not.

In all likelihood, if photographs are done routinely, it would be difficult to prove that it a consequence of an abnormal finding. The trouble occurs when there is no abnormal finding and it is coded to think that there is something coverable. This is highly debatable since a lack of an abnormality means there is no medical necessity even if there is a history of a systemic problem.

 

[Eric Newberry]

Probably it is difficult to discern whether the photography was subsequent to a retinal examination. However, many EHR's time stamp various points in an examination and if a situation were to arise it is possible to tell whether the retinal examination was done before the photograph or not.

In all likelihood, if photographs are done routinely, it would be difficult to prove that it a consequence of an abnormal finding. The trouble occurs when there is no abnormal finding and it is coded to think that there is something coverable. This is highly debatable since a lack of an abnormality means there is no medical necessity even if there is a history of a systemic problem.

I struggle with this chicken and the egg concept daily, especially with retinal nevi. We take and charge for screening retinal photos routinely. They are the first thing on my screen when I go into the room. I like to get a gross idea of retinal health before I begin refracting. I also quickly review corneal topography on each patient before retraction. I feel this saves me significant time in some cases. I feel it's silly if there is an obvious retinal nevi that I feel needs following, I have to then "order" another photo to be taken at end of exam just to meet insurance requirements. We do it, but its crazy!