Optometry Coding & Billing Alert Your practical adviser for ethically optimizing coding, payment, and efficiency in optometry practices

Transcription

1 The Coding Institute AVOID AUDITS.IMPROVE REIMBURSEMENT.REDUCE DENIALS.INCREASE REVENUE Optometry Coding & Billing Alert Your practical adviser for ethically optimizing coding, payment, and efficiency in optometry practices Also Access Your Alert Online at January 2014, Vol. 12, No. 1 (Pages 1-8) In this issue Compliance Focus on 5 Areas for Improvement in Your Provider Documentation While EMRs improve legibility, they may lead to other issues. Part B Payment Congress Offers 3-Month Reprieve on Conversion Factor Cuts Plus: Government moves toward possible SGR repeal. You Be the Expert Gonioscopies With Photos E/M Coding Follow The 3-Year Rule To Determine Patient Status Hint: The place of service (POS) won t influence your choice. p3 p5 p5 p6 Extended Ophthalmoscopy } 4 Tips Help You Scope Out Clean Claims Remember: Documentation and proper bilateral billing are key. Most eye exams include some form of ophthalmoscopy, but payers often bundle this service into general ophthalmic exam, or E/M codes. So how do you know when the exam warrants an EO code? You ll have to rely on detailed documentation to prove medical necessity and capitalize on the more complicated service Read on to make sure you re not missing out on EOs you could rightfully report. Tip 1: Know When to Take Coding to the Next Level Any general ophthalmic examination will include a routine ophthalmoscopy. But an extended ophthalmoscopy is a special ophthalmologic service that goes beyond the general eye exam. Caution: The general ophthalmic examination codes ( ) already include the routine ophthalmoscopy, so you should not report routine ophthalmoscopy (which can include a slit lamp examination with a Hruby lens or direct ophthalmoscopy for fundus examination) separately with When an initial exam uncovers a serious retinal problem, retinal specialists then turn to extended ophthalmoscopy (92225, Ophthalmoscopy, extended, with retinal drawing [e.g., for retinal detachment, melanoma], with interpretation and report; initial; and 92226, subsequent) for a more detailed examination. Reader Questions Append GY to Refraction Claims POS Determines Supply Reimbursement p7 p7 Consider this example: An obese female patient presents with headaches, slightly reduced vision in her right eye, vague complaints of soreness and variable blur. A routine ophthalmoscopy shows an elevated disc, so the OD decides to perform EO with a Volk 78 lens (although the definition of EO does not refer to any particular type of lens, notes David Gibson, OD, FAAO, a practicing optometrist in Lubbock, Texas). The EO reveals papilledema. On this claim, report the following: for the EO Modifier RT (Right side) appended to to show that you are only billing for the patient s right eye (Papilledema, unspecified) linked to to prove medical necessity for the EO Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC 27713

2 The Coding Institute SPECIALTY ALERTS Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC Editorial Advisory Board Jean Acevedo, CPC, LHRM Senior Consultant Acevedo Consulting Inc. Catherine A. Brink, CMM, CPC President, Healthcare Resource Management Inc., N.J. Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC President, CRN Healthcare Solutions Tinton Falls, N.J. Teresa S. Coles, Esq., MLIS, CPC Founding Member, Physician Advocate Consultants and Trainers, N.J. Member, American Academy of Professional Coders National Advisory Board Ramona Cosme President Ramco Medical Billing Inc., N.J. L. Michael Fleischman, CHC, CHCC Principal Gates, Moore & Company, Ga. Terry A. Fletcher, BS, CPC, CCS-P, CCS Healthcare Coding Consultant President/CEO, Terry Fletcher Consultants, Calif. Member, American Academy of Professional Coders Stephanie L. Jones, NRCMA, NRCAHA, CPC Vice President of Operations Aztec Medical Systems, Miami Janet McDiarmid, CMM, CPC, MPC Past President, American Academy of Professional Coders National Advisory Board Jeffrey P. Restuccio, CPC, CPC-H, MBA Principal Owner Tip 2: Remember to Include Detailed EO Documentation For an initial extended ophthalmoscopy exam, use 92225, and for all subsequent exams, use 92226, as the code descriptors indicate. While standard documentation will be sufficient for your routine ophthalmoscopy claims, you ll need more notes to back up your EO claims. EO is a detailed, extra, separate procedure requiring additional documentation with interpretation and report. The documentation should include the reason the optometrist performed an extended exam as well as the procedure he used. Also include a drawing of the area on the fundus in question (like the disc). A color drawing, even with just red and blue colored pencils, would be best, but it is not required by every carrier. If you have any documentation concerns on your EO claims, check your payer contract or call the payer before filing. Tip 3: Bill Bilaterally Based on Carrier While you re unable to report most of the other ophthalmic testing codes in the 92xxx series bilaterally, you can report and for each eye if there is a medically necessary reason. EO is a unilateral procedure. Although CPT doesn t specifically describe the procedure as unilateral in the code descriptor, most insurers follow Medicare s lead. You can find the bilateral surgery indicators in the fee schedule. Check column Z of the database, marked Bilat Surg. The fee schedule assigns a bilateral surgery indicator of 3, which means that Medicare has set the relative value units (RVUs) for gonioscopy based on the optometrist performing the procedure unilaterally. If there is a problem with both eyes, you can report the service for both eyes. Depending on insurer preference, report bilateral EOs with either: (Bilateral procedure) or RT (Right side) and LT (Left side). Prove it: Don t assume both eyes have the same diagnosis. You must report ICD-9 codes showing medical necessity in each eye you performed EO on. Consult your carriers local coverage determinations for diagnosis codes that support medical necessity. Tip 4: Don t Rule Out Other Services There are many times when you have to shy away from reporting more than one service during an encounter. When both services are medically necessary, however, you can report an extended ophthalmoscopy on the same day as a minor procedure or other service. Optometry Coding & Billing Alert (ISSN x for print; ISSN for online) is published monthly 12 times per year by The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC The Coding Institute. All rights reserved. Subscription price is $299. Periodicals postage is paid at Durham, NC and additional entry offices. POSTMASTER: Send address changes to Optometry Coding & Billing Alert, 4449 Easton Way, 2nd Floor, Columbus, OH, p2

3 Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC The Coding Institute SPECIALTY ALERTS CPT classifies extended ophthalmoscopies as special ophthalmologic services. According to CPT 2010, these special ophthalmologic services may be reported in addition to general ophthalmologic services or E/M codes. Often the extended ophthalmoscopy is what determines if a minor or major procedure is necessary. You can therefore report and within the global period of another procedure as well, if the documentation proves medical necessity. Consider this example: A new patient presents for a routine eye exam with no significant complaints except a diagnosis of type 2 diabetes. Her last exam was 18 months ago and she does not recall being told of any ocular complications of her diabetes. The exam reveals dot/blot hemorrhages and exudates in both eyes, but the right eye is worse. The optometrist documents the areas of disease in both eyes and orders an OCT (92134, Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina) of the macula to further evaluate the macula since some of the exudates superior to the macula could be affecting macula integrity. But wait: Why do an EO in this case instead of fundus photography (92250)? Medicare and some private carriers will not pay for OCT and fundus photos in the same visit due to (the insanity of) the CCI [Correct Coding Initiative] which prevents so-called duplicate procedures, explains Gibson. In this instance, you should report the EO codes. On the claim, include the following along with your EO codes: (Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits) for the general exam LT (Left side) to represent the EO LT for the OTC (Retinal edema) linked to 92014, and to prove medical necessity for the encounter. Skip 25: In many cases, you need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M or eye service code when you are reporting a code for a minor procedure performed during the same visit. You do not need modifier 25, however, when reporting with or q Compliance } Focus on 5 Areas for Improvement in Your Provider Documentation While EMRs improve legibility, they may lead to other issues. When your practice faces an audit, the payer is not only going to look at your coding accuracy, but also your documentation compliance. If you fall short, you could be setting your practice up for paybacks, fines, or worse. Ensure your providers documentation will stand up to payer and government scrutiny by focusing on these five key areas for improvement. 1. Start with Authentication Requirements Every medical record must have authentication. Every service your medical staff provides or orders should be authenticated by the author, says Marsha S. Diamond, CPC, CPC-H, CCS, coding textbook author and past AAPC National Advisory Board member and past Greater Orlando (Fla.) AAPC Chapter President in the Audioeducator.com audioconference Compliance: It s Not Just About Coding. All notes should be dated, preferably timed, and signed by the author. Authentication must be either a handwritten or an electronic signature. Note that signature stamps are not acceptable for Medicare and many other payers. In the office setting, initials are acceptable as long as they clearly identify the author. Handwritten signature will be considered a mark or sign. If the signature is illegible, Medicare shall consider evidence in a signature log. Lack of such supporting documentation will result in claims denial. Remember: Every note must stand alone, meaning that the performed services must be documented at the onset. The medical record must stand on its own with the original entry corroborating that the service was rendered and medically necessary. (Continued on next page) p3

4 The Coding Institute SPECIALTY ALERTS Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC Ensure legibility: Every entry in a patient s medical record must be legible to another reader to a degree that a meaningful review may be conducted. If the signature is not legible and does not identify the author, a printed version should also be recorded. 2. Check Timing Requirements When your providers actually complete their documentation matters. Documentation should be generated at the time of service or, as Medicare puts it, shortly thereafter, Diamond explains. Delayed entries within a reasonable period of time are acceptable for the purposes of: Clarification Error correction Addition of information initially not available Unusual circumstances prevented generation of note at time of service (for example, if your EMR system is not working). Rule of thumb: Payers don t typically give a set timeframe on what qualifies as shortly thereafter. Diamond explains that the rule is usually that you are in good shape as long as the documentation is in the chart and documented in the time that the author has total recall of the patient encounter or service. 3. Be Careful Making Alterations The medical record cannot and should not be altered. Errors must be legibly corrected so that the reviewer can draw an inference to its origin. If your provider makes a correction, he should include the date and (preferably) the time of the amended. Then, the person making the change should also legibly sign or initial the entry. Example: Your provider accidently copies and pastes a sentence from one patient s record into another patient s record. Someone in your practice catches the error later on. Even if you realize that you put it on the wrong patient s record or that that comment is totally inappropriate for that particular patient, then it should not be taken out of the record, but corrected using an appropriate method such as lining through it and initialing above it and the date [added and a statement] to say that was an error. Be clear: Delayed written additions/explanations serve for clarification only and cannot be used to add and authenticate services billed and not documented at the time of service or to retrospectively substantiate medical necessity. For example, if your practice did an audit and found that one of your providers was billing based on time but never included the total time spent with the patient in the chart notes, you cannot go back later on and add the time to support the billing. 4. Know the Rules for Using Scribes If a nurse or non-physician practitioner (NPP), such as a physician assistant (PA) or nurse practitioner (NP), acts as a scribe for the provider, the individual writing the note or entry in the record should note written by (name of NPP), acting as a scribe for Dr. (Physician Name). The physician should then co-sign and date the record, and also indicate that the note accurately reflects work and decisions he made during the encounter. It would be inappropriate for an employee of the physician to make rounds or see patients at one time and make entries in the record and then the provider make rounds later and note agree with above, unless the employee is a licensed, certified provider (NP/PA) billing for services under his/her own name/number, Diamond says. 5. Watch Out for EMR Pitfalls With the introduction of electronic medical records (EMRs) the capability of carry over, repetitive fill ins, and cloning has become prevalent, Diamond says. Remind your providers and coding/billing staff that only medically necessary information is considered when you are deciding on the code to bill based on supporting documentation. Copy and paste, cloning, and the act of carrying information forward from another record or another portion of the record has the same effect on the integrity of the medical record. Eventually, there will be contradictions in a patient s record. Payers obviously frown on this type of documentation. Example: First Coast Service Options, the MAC in Florida, prohibited the practice of cloning in its 2006 Medicare Part B newsletter ( com/publications_a/2006/ pdf), which states Documentation is considered cloned when each entry in the medical record for a beneficiary is worded exactly like or similar to the previous entries. Cloning also occurs when medical documentation is exactly the same from beneficiary to beneficiary. It would not be expected that every patient had the exact same problem, symptoms, and required the exact same treatment. p4

5 Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC The Coding Institute SPECIALTY ALERTS First Coast further states that discovery of this type of documentation will result in denial of services for lack of medical necessity and recoupment of all overpayments made. Bottom line: Cloning of documentation is considered a misrepresentation of medical necessity requirement for coverage of services. Credibility of the record is compromised and an auditor will be unable to determine what is accurate and how much work was done on one visit versus another. q Part B Payment } Congress Offers 3-Month Reprieve on Conversion Factor Cuts Plus: Government moves toward possible SGR repeal. If you weren t looking forward to the 20+ percent conversion factor cut that was scheduled to hit on Jan. 1, a great holiday gift arrived from Congress late last year. On Dec. 19, Congress approved a 0.5 percent increase to Medicare payments (over 2013 payment amounts) instead of the huge conversion factor cuts that were supposed to take effect in January. Although the fix is only good through the end of March, that three month period could be just what the government needs to fix the Medicare payment system for good. That s because Congress may actually be poised to eliminate the sustainable growth rate (SGR) formula and institute more modern payment systems for Medicare claims. You May Say Goodbye to SGR In December, the House of Representatives Ways and Means Committee and the Senate Finance Committee approved a bill that would eliminate the SGR in favor of freezing or slightly increasing 2014 payments over the 2013 amounts until a more permanent solution to how to calculate Medicare pay could be devised, which would largely be based on physician performance. Reform is needed to maintain a viable fee-for-service system and an emphasis on value mirrors many private payer efforts, the House Ways and Means Committee said in its overview of the SGR repeal proposal. While the duration and size of the payment rates to be set in statute are not yet determined, this phase will provide physicians time to transition to, and play a prominent role in, reforming the Medicare fee-for-service physician payment system. Medical Societies Applaud Move Needless to say, physicians have been thrilled with the news that the flawed Medicare payment system could finally get a facelift. Today s strong, bipartisan votes by the Senate Finance and House Ways and Means committees, following similar action last July by the House Energy and Commerce Committee, shows that there is overwhelming, bipartisan support for ending SGR in a fiscally responsible manner and closing the book on the annual cycle of draconian Medicare physician payment cuts and short-term patches, said AMA President Ardis Dee Hoven, MD, in a Dec. 12 statement. This long-overdue policy change provides the stability that physicians need to pursue delivery innovations that help improve patient care and reduce costs for American taxpayers. The AMA urges physicians to contact Congress in support of the payment overhaul by visiting fixmedicarenow.org/physicians. To read a summary of the House Ways and Means Committee s proposal, visit waysandmeans.house.gov/ uploadedfiles/sgr_reform_short_summary_2013.pdf. q Gonioscopies With Photos You Be the Expert Question: Our optometrist saw a glaucoma patient and performed a gonioscopy. The optometrist also took slit lamp photographs to document an iris nevus during the same session. Can we report the procedures separately? Kentucky Subscriber Answer: See page 7. q p5

6 The Coding Institute SPECIALTY ALERTS Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC E/M Coding } Follow The 3-Year Rule To Determine Patient Status Hint: The place of service (POS) won t influence your choice. The first step to consider in determining the appropriate evaluation and management (E/M) code for a service your dermatologist provides is whether the patient is new or established. Your choice is made easy if you know how to apply the three-year rule. Turn to CPT for Guidance A key factor in determining whether a patient is new or established is time, and you must decide whether your provider has seen the patient in the past, and if he has, how long ago. Rule: CPT clearly defines what qualifies as an established patient: An established patient is one who has received professional services from the physician/ qualified healthcare professional or another physician/ qualified healthcare professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years. In CPT parlance, professional services are those faceto-face services rendered by physicians and other qualified health care professionals who may report evaluation and management services reported by a specific CPT code(s). Ask yourself, Has the patient seen the provider in the past three years? Here s how to code based on your answer: Yes: If your provider has billed for a professional service in the past three years for a patient, you ll report the visit using established patient E/M codes (such as ), says Becky Boone, CPC, CUC, certified reimbursement assistant for the University of Missouri Department of Surgery in Columbia. No: If your provider has not seen the patient within the past three years and neither has another provider of the same specialty and subspecialty in the same group practice, you can report a new patient E/M code (such as ), instructs Christy Shanley, CPC, CUC, administrator for the University of California, Irvine department of urology. Don t Assume a New Provider Means New Patient If the patient has been seen before within the same practice, even though he switched doctors, he may be an established patient. If you are in a group physician setting, under the same tax ID, you have to determine if the patient has seen any of the doctors (of the same specialty) and when before you can decide on a new or established patient code. Avoid Coding Based on Location You should not use place of service (POS) for determining new versus established patient. Based on CPT s established patient definition, new versus established refers to the patient s relationship to the physician, not his relationship to the practice or its location. POS is irrelevant, Shanley says. Even if your physician saw a patient in the emergency room rather than in your office, the next time your provider or one of his associates in the same specialty sees that patient he is an established patient. Guideline: If a physician provides professional services to a patient in the hospital, all of his partners (physicians) in the same specialty, with or without the same tax identification number, who provide subsequent office or outpatient care must consider the patient an established patient and bill the appropriate established patient office visit code ( ). Pay Attention When Physicians Change Practices All of these new versus established patient rules also apply to a new physician in your practice. If the new provider has provided professional services to a patient elsewhere, such as in a hospital or other practice, within the last 36 months, the patient is an established patient even if this is his first visit to your practice. If a patient s doctor leaves the practice but the patient starts seeing another doctor within that practice, the patient is still established because the physicians (assuming they re in the same specialty) use the same tax ID, Boone says. And if that patient follows the doctor to a new location, s/he is still an established patient. To determine new or established patient payments, insurers will look at the provider s National Provider Identifier (NPI), not where the service was provided. q p6

7 Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC The Coding Institute SPECIALTY ALERTS Reader Questions } Append GY to Refraction Claims Question: A doctor recently told me that appending modifier GY to the refraction code would guarantee payment by a secondary insurer when Medicare denies it. Is this true? Illinois Subscriber Answer: Modifier GY (Item or service statutorily excluded or does not meet the definition of any Medicare benefit) does not guarantee payment from a patient s secondary insurance but that doesn t mean you shouldn t append it. One of the few constant and heavily documented truths in coding is that Medicare will never pay for refractions (92015, Determination of refractive state). Some non- Medicare insurers will pay for the service, however. A patient who has supplemental insurance in addition to Medicare may need to show the secondary insurer Gonioscopies With Photos You Be the Expert (Question on page 5) Answer: Normally, you cannot report a gonioscopy and slit lamp photographs together because Correct Coding Initiative (CCI) edits forbid it. On the other hand, you can report the two services separately using modifier 59 (Distinct procedural service) and separate diagnosis codes in certain circumstances. Because the optometrist performed the gonioscopy and the slit lamp photos for different reasons, you can report both procedures: Link the appropriate iris nevus diagnosis code (224.8, Benign neoplasm of eye; other specified parts of eye) to (External ocular photography with interpretation and report for documentation of medical progress [e.g., close-up photography, slit lamp photography, goniophotography, stereophotography]) for the photos. Attach modifier 59 and the appropriate glaucoma diagnosis code (365.x) to (Gonioscopy [separate procedure]) to represent the gonioscopy. You should also document the physician s findings and the condition s status in the interpretation and report for the test. Why? The modifier tells the insurance carrier that the iris nevus and gonioscopy were separate procedures, not components of one another. Because appears in column 2 of the CCI edits, append the modifier to that code and not 92285, which is the column 1 code. q that Medicare denied the refraction claim in order to be reimbursed for it. In those cases, you can submit a claim of GY to Medicare. This notifies Medicare that you re aware that the service isn t covered, but you re billing simply to obtain a denial for submission to a secondary payer or billing the service at the insistence of the patient. Medicare will automatically deny the claim, and the explanation of benefits will state that the patient is liable for the charge. Best bet: Have patients pay for the service in advance unless your records show that the secondary insurance paid for a previous refraction. q POS Determines Supply Reimbursement Question: My doctors are concerned that our practice is losing money on supplies, such as surgical trays, that they use during in-office procedures. Should we be billing for these necessary supplies? Pennsylvania Subscriber Answer: The answer depends on the payer you re billing and the contract you have with that payer. If you perform office-based (non-hospital) procedures, most insurers include payment in the procedure s fee for supplies, such as needles, surgical trays, dressings, sutures, guides, scalpels, and puncture sets. Tip: Although Medicare and private payers consider most supply costs associated with procedures covered under the procedure s payment, private payers reimbursement policies vary, so you should check with each of your payers. Facility difference: Payers normally reimburse facilities (such as hospitals or ambulatory surgical centers) directly for supply costs when your physician performs the procedure at the facility. But even though HCPCS codes exist for many of these items (such as A4550 for a surgical tray), most insurers will not pay your practice for the supplies separately when the physician performs the surgical procedure in an office. In fact, the Medicare Physician Fee Schedule usually reimburses more for non-facility (office-based) procedures than those performed in a facility. Medicare reasons that the office procedures include payment for the drugs, supplies, and equipment that the physician uses during the in-office service. Because hospitals bill for these supplies independently, physicians who perform hospital-based procedures will collect reimbursement for the professional procedure only and not the supplies. q p7

8 The Coding Institute SPECIALTY ALERTS Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC AVOID AUDITS.IMPROVE REIMBURSEMENT.REDUCE DENIALS.INCREASE REVENUE Optometr y Coding B i l l i n g A L E R T We would love to hear from you. Please send your comments, questions, tips, cases, and suggestions for articles related to Optometry Coding & Billing Alert to the Editor indicated below. Jerry Salley, CPC [email protected] Executive Editor Mary Compton, PhD, CPC [email protected] Editorial Director The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC Tel: Fax: [email protected] Optometry Coding & Billing Alert is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional services. If legal advice or other expert assistance is required, the services of a competent professional should be sought. CPT codes, descriptions, and material only are copyright 2013 American Medical Association. All rights reserved. No fee schedules, basic units, relative value units, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. Rates: USA: 1 yr. $299. Bulk pricing available upon request. Contact Medallion Specialist Team at [email protected]. All major credit cards accepted. This publication has the prior approval of the American Academy of Professional Coders for 0.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the Academy of the content. To access each issue s CEU quiz, visit Supercoder.com/ceus and then login. To request login information, [email protected] The CEU is valid for 1 year from issue s month. Anesthesia Cardiology Dermatology Emergency Medicine Family Medicine Gastroenterology General Surgery ICD-10 Coding Internal Medicine Neurology & Pain Management Neurosurgery Ob-Gyn Oncology & Hematology Jennifer Godreau, CPC, CPEDC [email protected] Director of Development & Operations The Coding Institute also publishes the following specialty content both online and in print. Call for a free sample of any or all of the specialties below: Ophthalmology Orthopedics Otolaryngology Pain Management Part B (Multispecialty) Pathology/Lab Pediatrics Physical Medicine & Rehabilitation Physical Medicine & Rehabilitation Podiatry Practice Management Psychiatry Pulmonology Radiology Urology Call us ( ) and mention your customer number for a special price, free trial, or just to find out more about SuperCoder the complete online medical coding solution. Order or Renew Your Subscription! Yes! Start/Renew my one-year subscription (12 issues) to Optometry Coding & Billing Alert Print & Online - $399 (Special Renewal price for active subscribers - $299 only!) Print only - $299 Online only - $199 Name Title Company Address City, State, ZIP Phone Fax * Must provide address if you choose online or both option to receive issue notifications To help us serve you better, please provide all requested information Payment Options Charge my: MasterCard VISA AMEX Discover Card # Exp. Date: / / Signature: Check enclosed (Payable to The Coding Institute) Bill me (please add $15 processing fee for all bill me orders) Optometry Coding & Billing Alert The Coding Institute PO Box Atlanta, GA Call Fax [email protected] Promo Code: P14RAA01 Also Access Your Alert Online at p8