What Is Optometric Coding?

It is important for the doctors in the practice of optometry and opthalmology to maintain their accurate coding

. This helps in obtaining the right insurance claims for their services. Read on the article to know more about optometric coding.

In medical schools, the optometry professor would teach how to code an eye exam because that is an integral part of the syllabus and it also forms the foundation of the practice of any optometrist. However there exists a widespread confusion regarding this billing and coding services closely associated with the eye-care service that is provided by the doctors. There are numerous doctors who do not really know what proper codes and right modifiers to use in order to code an eye examination. Many doctors are even unfamiliar with requirements associated with each code for a specific examination and therefore employ wrong techniques like reduced services and "time of service" discounts.

These wrongs that are done by the optometrist evidently attract unwanted scrutiny from the insurance companies. In the following read there are easy, appropriate and simple techniques that are mentioned to employ optometric coding in the right way so as to obtain the correct payment from the services that you as an optometrist provide to your customers.

Including the visits of consultation, there are basically 16 different ways in which the eye examinations can be coded. Ophthalmic practices use some general codes like ICD-9 for diagnosis, CPT for eye procedures, and HCPCS for additional procedures that are not included within the CPT codes. It is of paramount importance to understand the uses of the codes. The aforementioned codes further include 4 visit codes, 10 management and evaluation codes and also two HCPCS codes. All these codes are appropriate for procedures within ophthalmology.

These optometric codes are the best when used for examinations that are general in nature, but they do not necessarily cover every situation. There may be services which you provide that do not fit with the eye code guideline, for such a case, the evaluation and management codes need to be used. The CPT codes help to detail all the components used in an examination.

Medical examination of a new patient and diagnostic treatment initiation can be coded by 92002 codes of the opthalmologic services; the code 92004 may be used for the new patient for more number of visits. The codes like 9012 and 9014 can be used for the same services for established patients respectively. But it is necessary to understand that the codes just mentioned do not include the refraction service. This service is separate and must be billed distinctively.

While using the optometric coding technique, you must be aware of the associated discriminations. Several insurance guidelines state that there must be a single fee schedule for each code of CPT. Thus, for a particular CPT that you use; you must charge the same fee to all the patients for the same service, irrespective of whoever paying for the bill. Multiple schedules of fee are regarded as discriminatory and this might lead to reduction in the reimbursement from the carriers that you have. In some worse cases the carriers may regard that you have been abusive in billing and thereby charge you with monetary damages. Thus the codes, if followed properly will help you to comply with insurance guidelines.

by: Karen Van Laningham

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