Coding Q&As
Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., and Rebecca Wartman, O.D.
From the March 2015 edition of AOA Focus, page 51.
AOA's Coding Experts share more solutions to your coding conundrums.
What will happen with PQRS once the conversion to ICD-10 takes place?
The transition to ICD-10 is scheduled for October 1, 2015. After October 1, PQRS measures that were currently associated with specific ICD-9 diagnosis codes will be required to be linked to specific ICD-10 codes. The Centers for Medicare and Medicaid Services (CMS) has already published the ICD-10 codes that are associated with the PQRS quality measures for 2015. To assist members, AOA has an updated list of 2015 PQRS quality measures commonly reported by doctors of optometry and the associated ICD-10 codes for each measure.
Can I resubmit a claim if I forgot to include PQRS reporting information on the claim?
No, unfortunately claims cannot be resubmitted solely for the purpose of adding PQRS reporting information.
Am I required to use a registry for 2015 PQRS reporting?
No, a registry is not required for PQRS reporting in 2015. While CMS has indicated that it is their ultimate goal to eliminate claims-based reporting in favor of other reporting methods, such as registry-based and EHR-based reporting, for 2015 doctors of optometry can continue to participate in PQRS via claims-based reporting. Successful participation via claims or other PQRS reporting methods in 2015 will allow a doctor of optometry to avoid the 2% payment penalty that will be applied in 2017.
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Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2023, the AOA continues to press for Congress to act on reforms that would give doctors of optometry an annual, permanent inflationary Medicare payment tied to the Medicare Economic Index.
Modifier -25: How to use it appropriately and avoid costly penalties
The federal government and private payers are heavily scrutinizing the use of modifier -25. When used appropriately, it can help to ensure that patients receive appropriate treatment and that doctors of optometry are reimbursed appropriately for their service. If you believe a claim that includes modifier -25 was inappropriately denied, follow appropriate criteria when appealing.
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