Review of Optometry -
[Cached Version]
Published on: 7/24/2004
Last Visited: 7/24/2004
Optometrist Mike Todd of Augusta, Kan., who is the chairman for the American Optometric Association's subcommittee for coding, adds, "Patients may try to get you to file their medical exams under vision because medical insurance usually involves a deductible, and they don't want to have to pay that," he says."Or, they may ask you to file a medical exam for a vision exam because they have already used their vision benefits."Dr. Todd warns that pleasing the patient could get you in trouble because you have to legitimately be able to say the visit was a vision examination or that there was a definite diagnosis for a medical ex-amination.
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While optometrists are not excluded from using the level 5 codes, Dr. Todd says they may fall under suspicion for using the codes excessively."Internal medicine physicians who are in a hospital setting and see really sick patients who have complicated diagnoses might use these codes fairly often," he says."But, in the normal optometric practice setting, you're not going to be seeing those types of patients that often, so these codes should not be used that often."
10. Not providing the address for Medicare's Jurisdictional Pricing.Dr. Todd says that, more re-cently, optometrists have had to contend with refusal of coverage as a result of not writing the name, street address and zip code of where the service was performed in box 32 of the Centers for Medicare & Medicaid Services (CMS) claim form 1500.He says that it is his understanding that even if the doctor fills in the same name and practice everywhere else on the claim, that Medicare will not process the claim.
Indeed, according to Medicare, effective April 1, 2004, failure to report this information will prevent the claim from being processed, and the O.D. will not be afforded appeal rights.
11. Not providing Medicare with the necessary information for comanagement of cataract surgery.Dr. Todd and his billing administrator, Gloria Buthe, say optometrists can run into problems with this claim by:
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"You have to provide the date the procedure was performed (discharge date); the date you took over care (accepted care date); and the number of days you care for the patient post-operatively, or you will get a denial," Dr. Todd says.
• Forgetting to coordinate coding with the surgeon's office."The surgeon must file the claim for surgery with the -54 modifier, indicating the O.D. will provide the postoperative care," Dr. Todd says.
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