AOA Coding Experts gain AMA CPT appointments
Optometry's authority for all things billing and coding, the AOA Coding Experts maintain the profession's presence on the nation's preeminent medical coding bodies with recent appointments.
This past October, Doug Morrow, O.D., and Rebecca Wartman, O.D., received appointments to the American Medical Association's (AMA's) Current Procedural Terminology ® (CPT) Editorial Panel and CPT Assistant Editorial Board, respectively. Dr. Morrow was re-appointed to another four-year term on the AMA CPT Editorial Panel Health Care Professionals Advisory Committee (HCPAC), while Dr. Wartman was appointed to the CPT Assistant Editorial Board after serving as AOA's primary CPT advisor since 2016.
Alongside Harvey Richman, O.D., alternate advisor to the AMA CPT Editorial Panel HCPAC, Drs. Morrow and Richman, AOA's Coding Experts, hold seats on two elite AMA CPT coding committees. In addition to AOA's representation on the AMA Relative Value Scale Update Committee—by Charles Fitzpatrick, O.D., and Mark Shirey, O.D.—these doctors of optometry ensure the profession has immediate input on the decisions affecting coding and billing.
The sole body responsible for ongoing maintenance of the CPT code set, the AMA CPT Editorial Panel ensures codes that are required for use under Medicare, Medicaid and all HIPAA-covered entities reflect the latest medical care available to patients. Supporting the AMA CPT Editorial Panel are CPT advisors nominated by medical specialty societies and the HCPAC, on which optometry is directly represented.
Here's what Drs. Wartman and Morrow have to say about their roles on these prestigious AMA CPT coding committees.
What is the primary function of your AMA CPT position?
Dr. Wartman: The CPT Assistant Editorial Board is an authoritative source for the proper application of CPT codes in clinical situations. My primary role is to carefully review all the information and articles that the AMA CPT Assistant produces to further clarify how to code for new and not-so-new CPT codes, as well as to answer questions posed from around the nation about how to properly apply any particular code to a particular clinical case. CPT Assistant articles on any particular code are referenced in the CPT manual under the applicable code.
Dr. Morrow: I was elected by the HCPAC members to serve as a CPT Editorial Panel member, as one of two HCPAC members serving in that capacity. I will also serve as co-chair of the HCPAC. As a CPT Editorial Panel member, I am charged with sitting at the Editorial Panel table and considering code change proposals that are submitted for each meeting. Each panel member removes their association "hat" and considers each code change proposal as an impartial reviewer. We are each assigned to code change proposals as a primary or secondary reviewer. This job entails work to make sure the code change proposal is ready to be presented to the entire panel.
Optometry has been a HCPAC member since its inception in 1992, when we were one of the original professions on the HCPAC. The panel is where all coding decision reside, and all the codes that doctors of optometry use in their daily practice are approved, modified or deleted by this panel.
What does this appointment mean for optometry?
Dr. Wartman: My role as a member of the editorial board means that optometry can see all information before it is published and comment on and/or have input on many topics that are being addressed.
Dr. Morrow: I serve on the panel as optometry's representative. I must serve as an impartial judge as each code is presented. I was honored to be elected by my peers on the HCPAC to represent the group on the panel. It is the first time that optometry has had a member serving on this panel and gives optometry recognition as a member in the "house of medicine." I am able to offer my perspective on codes certainly with an optometry influence in my thinking and deliberations.
Access AOA coding resources
The AOA is optometry's leading source for education on medical billing and coding with all three AOA Coding Experts serving on AMA's CPT coding committees. So, take advantage of this unprecedented opportunity to utilize AOA's exclusive coding resources.
"There is a lot of information and people who lecture and write on coding issues; however, the AOA Coding Experts who write about coding, answer questions and present webinars and lectures are at the table when the codes are written and understand the proper applications and intent of the codes published by CPT," Dr. Wartman says. "As well, all of us stay on top of coding policies that are written by Medicare carriers and many of the private insurances. We all strive to present the most accurate, up-to-date information possible and in a timely manner."
Here are three ways that AOA members can make the most of AOA's coding resources:
- Ask the Coding Experts. AOA's Coding Experts are available to answer questions about ICD-10 and other coding topics through the this online form. Also, find the experts' regular column in AOA Focus.
- Use AOA Coding Today. This online, comprehensive database contains information in real time for CPT, ICD-10 and HCPCS coding and research. AOA Coding Today is tailored specifically to optometry and assists doctors and staff in correct reimbursement and compliance with an easy-to-use code diagnosis ability based on region.
- Watch AOA's coding webinars. Browse AOA's webinar library for additional coding tutorials.
Access AOA's Medical Records and Coding page.
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.
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.