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Advanced Coding Specialist ­ Ophthalmology (ACS-OH)

As a service to candidates, this outline is designed to provide representative examples of the coding and billing issues covered on the ACS-OH examination. While it should serve as a guide for your test preparation, you should not consider it inclusive of every procedure or issue addressed within the examination.

Examination Outline

Section One - Ophthalmology Medical Terms and Abbreviations

Abbreviations and medical terms, e.g. Cataract Background diabetic retinopathy Ambylopia Strabismus Vitreous SLE OD OS

Section Two - Evaluation and Management Scenario Coding ­ (92002-92014) (99201-99499)

Consultations and the ordering practitioner (e.g. eligibility) 1995 & 1997 guidelines (will be provided for reference) E/M surgeries Levels of service and when a higher level is appropriate Coding encounters in the ED Hospital visit codes Diagnosis coding to establish medical necessity (included in E/M questions) Use of E codes with encounters Components of ophthalmology physical examination Eye refraction billing rules Medicare

Section Three - Surgery

Lesion excisions (e.g. chalazion) Electrocautery of lesions Vitrectomies Cryocoagulation Retrobulbar injection Punctum procedures Sclerotomy YAG procedures Lacrimal procedures Glaucoma procedures Anterior segment procedures IOL insertion

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Section Four - Diagnosis Coding

Rechecks Glaucoma Diabetes Corneal abrasion Inflammation Pain E codes for external causes

Section Five - Modifiers

E/M and minor procedure Staged procedure Post-op unrelated service Eyelid modifiers Split surgery care Reduced service Locum Tenens ABN modifiers

Section Six - General Coding and Billing Issues

ABN Physician supervision rules Time lines for filing claims to Medicare Diagnosis coding for diagnostic tests LMRP A-scans Attending physician/resident modifier Global surgery modifiers Medicare secondary payer HIPAA Shared visits Medicare Time line for filing appeals Medicare Ophthalmoscopy

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