Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., and Rebecca Wartman, O.D.
From the July/August 2015 edition of AOA Focus, page 49.
AOA's Coding Experts share more solutions to your coding conundrums.
When reporting ICD-10 codes, when is it appropriate to use the family history diagnosis codes?
With regard to use of the family history diagnosis codes, the ICD-10 Official Guidelines for Coding and Reporting indicate:
As is noted in the guidelines, the family history diagnosis codes should be used if a patient is at higher risk for a disease due to family history or if the doctor is conducting a screening based in part on family history. For example, if an doctor of optometry was treating a 60-year-old patient, the patient had not had an eye exam in several years and the patient had a family history of glaucoma, the doctor should report the patient's family history of glaucoma using the ICD-10 code Z83.511 (family history of glaucoma). The complete guidelines can be accessed on the CMS website.
I am retiring from practice in 2016. Does AOA have resources that can help me learn about ICD-10 to get through my remaining months in practice
We highly recommend ordering the AOA's Codes for Optometry manual, available to members by calling the AOA Marketplace at 800.262.2210 or by visiting the AOA Marketplace.
Ask the coding experts
If you have any questions regarding Medical Records and Coding, please submit them by using the Coding Experts Submission Form and one of our coding experts will be in contact with you.
Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2024, 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.