Excerpted from page 49 of the November/December 2016 edition of AOA Focus.
AOA's experts share solutions to your coding conundrums.
Q. What do I do if a code requires a seventh character but is not six characters long? For codes that require a seventh character, but are not six characters long, you must use placeholder X to fill in empty characters.
Q. In ICD-10, what is the difference between the "Excludes1" and "Excludes2" notes? The Excludes1 notes indicate when two conditions cannot occur together (e.g., congenital versus acquired form of same condition). Excludes2 means that the excluded condition is not part of a condition represented by the code, but the patient may have both conditions at the same time.
Q. I understand there are new codes for diabetes. Does AOA have any examples of insulin and non-insulin drugs? Yes, a listing of insulin and non-insulin drugs is available at on the AOA website.
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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.
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.