Coding for Macular Degeneration 1. Office visit as above, 92 or 99 Frequency -As medically indicated (q 1mo, 3 mo, 6mo, 12mo) -No limit on office visits.

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Coding for Macular Degeneration 1

Office visit as above, 92 or 99 Frequency -As medically indicated (q 1mo, 3 mo, 6mo, 12mo) -No limit on office visits - AOA recommends q months, depending on risk & severity 2

Coding for Macular Degeneration Level of Office Visit - Severe AMD may support higher level - AMD complicated with other disease (eg, glaucoma) may support higher level 3

Coding for Macular Degeneration Special Tests Scanning Imaging (GDx, OCT) Visual Fields Fundus Photo Extended Ophthalmoscopy Genetic Test Misc Tests 4

Coding for Macular Degeneration Scanning computerized ophthalmic diagnostic imaging, posterior segment, retina retina 5

Scanning Imaging BluePeak™ Blue Laser Autofluorescence Imaging, FAF No dedicated CPT No dedicated CPT Am. Acad. of Ophth. recommends Unlisted service Average Medicare payment = $111 in 2008 Average Medicare payment = $111 in

Scanning Imaging BluePeak™ Blue Laser Autofluorescence Imaging, FAF Submit documentation, describe nature, extent, medical necessity, time, effort, equipment 7

Scanning Imaging BluePeak™ Blue Laser Autofluorescence Imaging, FAF Some use ( ↑ $$) LCD may not allow scanning laser or be silent file://localhost/Users/alanhomestead/Documents/My Documents B /Adventures /O - S/Presentations/A-O/Loose Pages/14 Bill Photo w Scan Laser.docx file://localhost/Users/alanhomestead/Documents/My Documents B /Adventures /O - S/Presentations/A-O/Loose Pages/14 Bill Photo w Scan Laser.docx 8

Coding for Macular Degeneration Visual Fields AOA suggests central 10 Deg annually 9

Coding for Macular Degeneration Visual Fields Foresee Preferential Hyperacuity Perimeter aka, Foresee PHP™ Visual field analyzer Tests one stimulus brightness level, matches Vendor recommends every 3-4 months for at risk 10

Coding for Macular Degeneration Visual Fields Foresee Preferential Hyperacuity Perimeter LCD may say: -visual field examinations performed at unusually frequent intervals may be reviewed 11

Coding for Macular Degeneration Extended Ophthalmoscopy Rare size requirement No color requirement 12

Coding for Macular Degeneration Genetic Test Macula Risk (ArcticDX, Toronto, Ontario) 1st genetic test for AMD

Coding for Macular Degeneration Genetic Test Obtain test kits from ArticDX (no cost) Take oral swab from patient (office visit) Results forwarded to doc (no fee to doc) Discuss results with patient (office visit) Lab bills insurance directly 14

Coding for Macular Degeneration Macular pigment optical density MPOD -no CPT -no CPT -can bill Unlisted service -can bill Unlisted service -collect from patient -collect from patient -Vendors: Macuscope by Marco, MPOD by Tinsley -Vendors: Macuscope by Marco, MPOD by Tinsley 15

Coding for Macular Degeneration Color Vision –AOA mentions ? 16

Diabetes file://localhost/Users/alanhomestead/Do cuments/My Documents B /Adventures /O - S/Presentations/Repository of My PowerPoints/1 Topic Modules/Diabetes/Diab Aug 13.ppt file://localhost/Users/alanhomestead/Do cuments/My Documents B /Adventures /O - S/Presentations/Repository of My PowerPoints/1 Topic Modules/Diabetes/Diab Aug 13.ppt 17