Healing an Injured Revenue Stream by Optometry Billing

Ask any optometrist what prevents him or her from establishing a successfully eye care practice. The answer invariably is the fear of claims being rejected due to improper coding or billing. Optometry billing plays a very vital role in Optometry revenue management, which, if done correctly will certainly help increase revenues. Always staying abreast of the billing a coding and knowing about the changes play a crucial role in receiving payments for the eye care provided.

Accurate Records

Maintaining accurate records is the first right step to ensure that you stick religiously to the Optometry billing guide. From the insurance point of view, it pays to take notes and present the case appropriately. It is the patient's major complaint that needs to be focused on. For instance, if the patient is in need of treatment for ocular allergies, the line of treatment should address that first (there may be other issues that need to be examined as well). Presenting the facts about how the physician went about the exam and the discussions he or she had with the patient and the exploration of the history of the patient should all be recorded meticulously.

Proper Follow up and Recommendation

During the office visit there are codes that stipulate that it is mandatory to follow a diagnostic treatment program. The records maintained by the physician should convey details of how the patient's major and ancillary complaints were handled and solved. The best solution need not be the cheapest one available; hence the focus should be on cure and not the cost. Justifying Optometry billing by the patient's inability to afford a particular line of treatment does not hold water with the insurance companies. Of course, the patients must be made aware of the choices available, which should be followed by recommendations. The best interests of the patients should always be paramount.

Which Code to use?

All services rendered and procedures followed are subject to CPT or Current Procedural Terminology, 4th Edition. The CPT-4 codes will include a 5-digit number that indicates the initial procedure, and can go up to four modifiers comprising 2-digit numbers. Optometry coding comprises choices of using 920XX codes for eye care, and 992XX and 920XX are used for ocular allergy. The code 992XX is also used by other healthcare specialties and warrant more detailed documentation, and are generally accepted by the payers. However, it is the 992XX codes that play a more dominant role in eye care, which Optometry coding companies should note. Eyecare physicians may describe office visits using a second coding system comprising the 920XX series.

Improper codes

Note that you cannot bill allergy using codes 92004 or 92014 even though it will enable you to get reimbursements at higher levels. However, during audit it will be pointed out that there isn't enough medical necessity evident from the medical record justifying such a code being used in Optometry coding for ocular allergy patients. Most of the ocular allergy patients will fall in any of the codes coming under level 2 or 3, which are 99202, 99203, 99212, and 99213. The evaluation would depend on various factors like history, examination, medical decisions made, etc. It is better for Optometry coding companies to consult either the 195 or 1997 Evaluation and Management Guidelines published by CMS (Centers for Medicare and Medicaid Services) for additional information.

The level of service should always be determined by taking into account three major factors: the history of the patient, in-depth physical examination, diagnosis and treatment based on medical decisions. All these need to be documented meticulously so that Optometry revenue management is carried out smoothly without any obstacles.

Published By - Medical Billers and Coders
Published Date - Oct-25-2016 Back

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