Co-managing Cataract Surgery? Avoid These 5 Billing Mistakes

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For many ECPs, co-managing an eye surgery patient presents several distinct advantages—the ophthalmologist can perform a surgical procedure, and an optometrist can manage the patient post-surgically. This type of collaborative care can be beneficial for all parties involved:

  • The patient can receive follow up care from his or her optometrist (with whom the patient may be more comfortable due to a pre-existing relationship).
  • Co-management could open up a new revenue stream for the optometrist.
  • The optometrist gets to see a greater variety of patients and conditions in addition to the routine eye care he or she may be used to providing.
  • The ophthalmologist no longer needs to spend time on follow-up care and routine eye exams, freeing up additional time for more surgeries—in addition to growing his or her referral network.

However, co-management relationships can also create billing challenges that you should know before you decide to pursue this type of relationship in your office.

Get to know the following five co-management caveats that could impact your eye care practice. Knowing and avoiding these five common co-management billing errors will prevent denials and keep your revenue cycle rolling along!

Look out for these five common co-management billing errors that lead to denials:

1. Using the patient’s post-op visit date as the date of service on the claim form, when it should actually be the surgery date. The claims for surgical care and post-op care must both list the same surgical date of service.

2. Not including the dates of assuming and relinquishing care on the claim form when physicians share postoperative care. Ensure you get reimbursed for each day you provide care during the global period by listing the date range in the appropriate field.

3. Using an E/M or eye code to bill for the post-surgical visit instead of the surgical procedure code (like 66984 for cataract removal).

4. Failing to bill separately when a new condition appears that is unrelated to the surgery or conversely, billing separately for a new condition that actually is surgically related.

5. Routinely billing for co-management on the date care was assumed. You can’t bill for co-management until at least one service has been provided to the patient. However, you don’t have to wait until the end of the global period to submit the claim.

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Photo Credit: Vinqui CC BY-SA 2.0

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