Ophmasters Banner

Coding and Reimbursement Update 2019


Jacqueline Thelian, CPC, CPC-I, CHCA
MedCo. Consultants Inc.
Fresh Meadows, NY

Mrs. Jacqueline Thelian is a Healthcare Consultant, Certified Professional Coder & Auditor, Subject Matter Expert and sought-after educator and Author with over 20 years of experience in medical coding and business management. Her extensive experience includes physician practice management, coding/billing compliance and reimbursement issues and she has taught extensively in Academic Medical Centers, The Chubb Institute, Hospitals, private physician practices and has conducted a variety of seminars for numerous Medical Societies.

She is also a AAPC Certified PMCC instructor for the PMCC (Professional Medical Coding Curriculum) Coding Certification Prep Course, and a Certified ICD-10 Expert Trainer. Her articles on clinical coding issues have been published in many popular healthcare publications.


Friday, June 28, 2019
8:00 AM - 2:30 PM

8:00 – 9:00 AM

Updates to CPT Codes and Medicare Fee Schedule

  • MACRA & MIPS Updates
  • New Category III Codes
  • Misvalued Services Updated
  • Electroretinography (ERG)
  • Echo Exams of Corneal Thickness
  • Local Coverage Determination (LCD) Updates

9:00 – 10:00 AM

Common Coding Errors Impacting Reimbursement

  • Failure to Follow National Correct Coding Initiative (NCCI) Edits
  • Lack of Supporting Documentation for:
    • Ophthalmoscopy
    • Interpretation & Reports for Diagnostic Testing
    • Utilization of Test Results in Treatment of the Patient
    • Images

10:00 – 10:15 AM


10:15 AM – 12:00 PM

Documentation and Coding Evaluation & Management (E/M) Services

  • Proposed E/M changes & the impact to your reimbursement
  • Understanding the Required Documentation for the Different Levels of Service
  • When to Append Modifier 25
  • When to Append Modifier 59
  • Understanding the “X” Modifiers
  • Supporting Documentation for Modifier Usage

12:00 – 1:00 PM


1:00 – 2:30 PM

Surviving an Audit

  • Difference between Commercial Carrier Audits & Medicare
  • Medicare Targeted Probe and Educate (TPE) Audits
  • How to respond to an audit request
  • Preparing your appeal
  • Settling the audit

Global Surgical Data Collection Requirements for Florida

  • Requirements for Reporting

Learn More About It

  • Links and Website to stay updated

Questions and Answers

2:30 PM

Course Adjourns


Target Audience

This program has been designed for physicians, nurses, coders, technicians, and administrators with a fairly good understanding of Medicare requirements, CPT and diagnosis code usage, and billing for services rendered.

Learning Objectives

  • Discuss the components of selecting the proper E/M code
  • Describe the various types of audits and how to respond
  • Implement proactive measures to stay compliant


CME/CE provided by AKH, Inc., Advancing Knowledge in Healthcare

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and the Florida Society of Ophthalmology. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.
AKH Inc., Advancing Knowledge in Healthcare designates this live activity for a maximum of 5.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physician Assistants

NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME.


AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
This activity is awarded 5.25 contact hours.

Florida Nurses

AKH Inc., Advancing Knowledge in Healthcare is an approved provider for nursing continuing education by the Florida Board of Nursing #50-2560. AKH Inc., Advancing Knowledge in Healthcare designates this educational activity for 5.0 contact hours.
Activity is jointly-provided by AKH Inc., Advancing Knowledge in Healthcare and the Florida Society of Ophthalmology.

Criteria for Success

Statements of credit will be awarded based on the participant’s attendance and submission of the activity evaluation form. A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.ophmasters.com/cme. If you have questions about this CME/CE activity, please contact AKH Inc. at tbrignoni@akhcme.com.

Commercial Support

Full notification of commercial support will be provided in the final course syllabus.


This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc., Advancing Knowledge in Healthcare specifically disclaims responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through reader’s misunderstanding of the content.

Disclosure Declaration

It is the policy of AKH Inc., Advancing Knowledge in Healthcare to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The faculty must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflict of interest is resolved by AKH Inc., Advancing Knowledge in Healthcare prior to accreditation of the activity. AKH/FSO planners and reviewers have no relevant financial relationships to disclose.

Disclosure of Unlabeled Use and Investigational Product

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.