Greetings! Please continue reading for important information regarding Medicaid eligibility and an ophthalmology coding alert. We hope everyone has a safe and happy holiday season!
|Important Medicaid Spendown Reminder|
|Medicaid spendown, otherwise referred to as deductible, means a patient will qualify for assistance in the Medicaid program after they pay a certain out of pocket portion of their monthly medical bills. The out of pocket amount a patient is responsible for is determined by Medicaid. Until that amount is paid, the patient does not qualify for Medicaid for that given month and should be treated as self pay. This means payment should be collected on the day services are rendered, and the patient can turn their receipt in to their caseworker to prove they have paid towards their spendown. When this happens we will not bill Medicaid for the service the patient paid for. lt is imperative to have spendown patients sign an Advanced Beneficiary Notice (ABN) acknowledging the patient is responsible for payment, and Medicaid will never be billed for those services. Please contact us if you have questions.|
| Ophthalmology Coding Alert for 2011|
Although scanning laser ophthalmic diagnostic imaging (SCODI) is commonly used as a diagnostic test for early detection of glaucoma, it is also a valuable tool for the evaluation and treatment of individuals with retinal disease, including individuals with diabetic retinopathy and macular degeneration. SCODI is able to detail the microscopic anatomy of the retina and the vitreo-retinal interface.
To distinguish between the two diagnostic purposes, CPT will delete the old all-purpose posterior segment SCODI code, 92135 (Scanning computerized ophthalmic diagnostic imaging, posterior segment [e.g., scanning laser] with interpretation and report), and replace it with these two new more specific codes:
>> 92133 - Scanning computerized ophthalmic diagnostic imaging, posterior segment with interpretation and report, unilateral or bilateral; optic nerve
>> 92134 - Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina
The Coding Institute. "92135 Update: Prepare to Distinguish Between Optic Nerve and Retina Laser Scans." Ophthalmology Coding Alert October 2010, Vol. 13, No. 10.