Paraoptometriic Codiing Certiifiicatiion
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1 Paraoptometriic Codiing Certiifiicatiion Study Map Preparing for the Certified Paraoptometric Coding (CPOC) examination will be a breeze with the many resources available through the AOA and other internet sources. The attached map lists the subject matter of the examination content along with suggested resources to prepare with. The Study Guide Map on the following pages connects the individual sections of the examination to suggested study resources. The CPC does not constitute an endorsement concerning these sources and does not imply a guarantee that candidates will be successful in passing the Certified Paraoptometric Coding examination. Please note that some Web sites shown require a membership sign-in and password. Additional material will be added CPT Standard Edition Evaluation and Management Guide AOA Paraoptometric Section AOA Coding Today Paraoptometric Coding Certification AOA Web site Centers for Medicare and Medicaid Services Web site 2011 Codes for Optometry
2 I. Anatomy and Physiology (8%) Outline Subject Matter Paraoptometric Coding Certification Study Map A. Eye Anatomy 2011 CPT Standard Edition p. xxxix 1. Definitions AOA Web site: 2. Functions ( B. Pathology and Pharmacology ( 1. Disease definitions ( 2. Common treatments AOA Clinical Practice Guidelines Resources ( Paraoptometric Certification CPO Review Course ( Paraoptometric Section Home Education Module (Anatomy and Physiology PS7) Paraoptometric Section CPO Study Guide (PS4) Paraoptometric Section Self Study Course (PS1) II. Medical Terminology (8%) A. Prefix 2011 CPT Standard Edition p. xviii xix 1. Numbers Paraoptometric Section Home Education Module (Anatomy and Physiology PS7) 2. Conditions Paraoptometric Section CPO Study Guide (PS4) 3. Directions/positions Paraoptometric Section Self Study Course (PS1) B. Suffix Paraoptometric Certification CPO Review Course 1. Procedures ( 2. Conditions AOA Web site: C. Root Words ( and Vision Conditions.xml) D. Abbreviations
3 III. Review of CPT (22%) 2011 CPT Standard Edition A. Development of Procedure Codes 2011 Codes for Optometry 1. Initial Purpose AOA Web site: 2. Evolution of the System ( 3. Current Maintenance B. Evaluation and Management (E/M) Services Guidelines 1. Definitions of elements of a service 2. Determination of extent of E/M components 3. Determination of level of E/M a. Role of the Documentation Guidelines for the E & M Services (1994 and 1997 editions) C. Evaluation and Management Categories 1. Office Services Definitions a. New patient b. Established patient Subsequent Nursing Facility Care Services Definitions a. New or established patient D. Surgery Guidelines ( 1. Follow up care 2. Surgical package definition 3. Multiple procedures 4. Surgical materials/supplies E. Ocular System Surgeries 1. Removal of Foreign Body Definitions a. (e.g , 65210, 65220, 65222) 2. Eyelids Procedures Definitions a. (e.g , 67820, 67938) ( b. Applicable global periods 3. Lacrimal System Procedures Definitions a. (e.g , ) b. Applicable global periods 4. Co management Procedures a. Intraocular Lens Procedures Definitions 1. (e.g , 66984, 66821) 2. Applicable global periods b. Other Surgical Procedures Definitions 1. (e.g , 66500, 66600, 67107) F. Diagnostic Procedures
4 2. Definition ( a. (e.g , 76510, 76516, 76519) G. Ophthalmic Guidelines 1. Definitions of service levels H. General Ophthalmic Services Definitions 1. New patient 92002, Established patient 92012, I. Special Ophthalmic Services Definitions 1. (e.g , 92020, 92070, 92081, 92082, 92083, 92100, 92133, 92134, 92060, 92065) J. Ophthalmoscopy Definitions 1. (e.g , 92226, 92250) K. Other Specialized Service Definitions 1. (e.g , 92285, 92230) ( L. Contact Lens Services 2. Definitions a. (e.g ) M. Spectacle Services 2. Definitions a N. Category II Codes a. Modifiers 2. Medicare Physician Quality Reporting System (PQRS, formerly PQRI) Centers for Medicare and Medicaid Services a. Purpose and current use Evaluation & Management Services Guide b. PQRS measures related to optometric care ( O. Category II Modifiers 1. Definitions 2. Types of modifiers a. 1P, 2P, 3P, 8P
5 IV. Diagnosis Codes (24%) A. Development of Diagnostic Codes 2011 Codes for Optometry 1. Initial Purpose Centers for Medicare and Medicaid Services 2. Evolution of the System ( 3. Current Maintenance ( B. International Classification of Diseases Ninth Edition (ICD 9) ( AOA Web site: 2. Categorization ( 3. Supplementary codes ( a. Guidelines for use See AOA Web site resources shown in Section III. C. Health Care Procedures Classification System (HCPCS) 2. Definitions a. Spectacle codes V2100 V2799 b. Contact lens codes V2500 V2599 c. Low vision codes V2600 V2615 d. Prosthetics codes V2623 V HCPCS modifiers D. Medicare Correct Coding Initiative (CCI) 1. History and purpose 2. Manual guidelines 3. Review of CCI edits table E. Overview of ICD Purpose 2. Implementation date
6 V. Medical Records (paper/electronic) (14%) Centers for Medicare and Medicaid Services A. Documentation Guidelines for the Evaluation and Management Services ( eds) Evaluation & Management Services Guide 1. Organization of medical records ( f) 2. Collection of information a. Use of abbreviations 3. Correction of information B. Retaining and purging 1. Statute of limitations 2. Protection of privacy C. Health Information Privacy and Accessibility Act AOA Web site: 1. History and Purpose ( 2. Disclosures of Protected Health Information (PHI) D. Medical Records Reviews and Audits 1. Internal 2. External E. Reasonable and Necessary (formerly Medical Necessity ) 1. Advance, Beneficiary Notice (ABN Form) a. Purpose b. Form requirements ( Medicare Learning Network ( pdf) ( Paraoptometric Section CPO Study Guide (PS4)
7 VI. Claim Filing (12%) A. CMS Form (formerly HCFA) AOA Web site: 1. Completion guidelines ( 2. Example form Centers for Medicare and Medicaid Services B. Timely Filing ( C. Redeterminations/Appeals ( ( VII. Compliance (12%) Centers for Medicare and Medicaid Services A. Compliance Program ( 1. Purpose ( 2. Development ( mguidance.asp) B. Contracts and Agreements ( 1. Medicare AOA Web site: a. Definition/description ( manual.pdf) b. Scope of practice ( c. Current policies ( 1. National Coverage Determinations (NCDs) 2. Local Coverage Determinations (LCDs) d. Medicare Provider Manual overview C. Other Carriers 1. Government 2. Private Plans 3. Third Party See AOA Web site resources shown in Section III VI
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