Ophthalmology Coding Seminars - Get Tips On Resolve Medical & Vision Insurance Coding

By Author: Angela Smith
Total Articles: 89
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A patient presents for what you expect will be a routine vision exam; however you find cataracts. So in this situation should you still report the service to the patient's vision plan or to his medical plan as the ophthalmologist detected a medical problem? Or both plans?
Here are some guidelines to see to it that you don't land in a soup with your patient, not to mention CMS.
For clues check CC and HPI
Base your decision on which plan to bill on the reason the patient is in the office. The important factors are the patient's chief complaint (CC) and history of present illness (HPI).
You should bill the medical plan if the complaint or diagnosis is problem related, and bill the vision plan if the patient came in for a routine eye exam and the diagnosis is for routine eye exam.
The patient has no complaint? Look to S0620-S0621
A patient goes to your ophthalmologist for a routine eye and has no complaints. So how would you code in this case? Which plan should you submit your claim to?
You will still code as per the chief complaint as to why the patient presented to the office ...
... of care. If the patient presents with no specific complaint, however the ophthalmologist diagnoses a medical problem, report the routine visit as the primary diagnosis and the medical condition as the secondary diagnosis. You should bill that visit to the patient's vision carrier. The diagnosis code should relate to the chief complaint; so when the patient has no complaints, the visit is routine unless added significant workup was required for problems detected during the encounter.
For further tests, have patient return
According to experts, when the ophthalmologist finds a medical problem during a routine exam, he might think of having the patient return on another day for any further tests rather than convert the exam from routine to medical. A Patient who presents for a routine screening with a $20 copay may be confused and upset when he sees a bill for a problem related medical eye exam, even if his out-of-pocket expenses are the same.
For more tips on ways to resolve ‘medical versus vision' insurance coding mix ups, sign up for ophthalmology coding seminars. In fact, if you're looking to attend one, you can head to Orlando, FL this December where you can attend an ophthalmology coding conference.