![]() ![]() Equally important is the need to review the explanation of benefits (EOBs) provided by payers. This is one of the main reasons why printing information out or using “cheat sheets” to determine what diagnoses support a procedure may not be beneficial. In fact, with the CMS initiative to consolidate payers, frequent coding changes have become the norm. Many regional payers change their LCDs throughout the year. What worked last year, or even last month, may not work now. Reimbursement guidelines change on a regular basis. One of the most common reasons for claim denial occurs when you assume that a diagnosis and procedural combination used in another part of the country will work in your region. Remember: No region completely follows the national guidelines. Suffice it to say that there are many distinct differences between national and local standards, as well as differences within each of the LCDs for various regions. Known as the National Coverage Determinatioan (NCD), individual payers can modify these standards based on a Local Coverage Determination (LCD). The Centers for Medicare and Medicaid Services (CMS) set a national policy for diagnoses that support various procedures. *This list simply provides the common ranges of some diagnoses.ĭepending on your billing region, there may be additional supporting codes.Ī thorough understanding of the hierarchy and history of medical billing is critical to successful coding for SD-OCT. 362.8x: Retinal––nerve fiber layer defects, edema, etc.362.4x: Retinal––layer separation, hemorrhages, etc.362.3x: Retinal––artery and vein occlusion.362.1x: Retinopathy––hypertensive, exudative, etc.Typical Billing Codes for Supporting Diagnoses Made With SD-OCT* This article explains how to code appropriately for SD-OCT and effectively maximize your reimbursement levels. Though clinicians recognize the value this technology brings to their practices, insurers can stand in the way of full reimbursement for diagnostic procedures involving SD-OCT. The introduction of spectral domain optical coherence tomography (SD-OCT) makes it possible to visualize large areas of the retina in greater detail than possible with standard OCT. ![]()
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