OPTOMETRIC BILLING
- By Blog Owner
- •
- 01 May, 2017
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EXAMS WITH SURGICAL PROCEDURES
Dear Readers, A quick note today:
Whenever you bill a surgical procedure to insurance (any procedure that begins with a '6') you MAY NOT bill an exam to that insurance company for the same day as insurance considers an exam to be PART OF THE SURGICAL PROCESS!
However, if you have a significantly DIFFERENT DIAGNOSIS CODE you may append the exam procedure with a -25 modifier and bill the insurance for both the exam and the surgery so long as the diagnosis code being used for surgery is ONLY POINTED TO THE SURGERY and the diagnosis code for the exam is ONLY POINTED TO THE EXAM!
Whenever you bill a surgical procedure to insurance (any procedure that begins with a '6') you MAY NOT bill an exam to that insurance company for the same day as insurance considers an exam to be PART OF THE SURGICAL PROCESS!
However, if you have a significantly DIFFERENT DIAGNOSIS CODE you may append the exam procedure with a -25 modifier and bill the insurance for both the exam and the surgery so long as the diagnosis code being used for surgery is ONLY POINTED TO THE SURGERY and the diagnosis code for the exam is ONLY POINTED TO THE EXAM!
How your optometric billing can help build your specialty clinic from the ground up.
Detection of early signs of glaucoma made easier with new technological advances.
Upgrading diagnostic tools to help improve your optometric billing.
Optical coherence tomography (OCT) scanning has come a long way in the development of its technology in the last two decades. How will these new advances in OCT affect how you practice optometry and your optometric billing?
"Everyone will come to you and you will be the one who refers them to different specialties". Maybe the eyes are more than just a window to the soul?
Eliminate or delegate things you spend your time on that don't improve your bottom line. Outsource things you must do well but can't/don't.
Received a question from a provider regarding Harvard Pilgrim
Some things to look for and some things to avoid when seeking optometric billing services.
When performing routine eye exams on Aetna Patients it is a good idea to get in the habit of using
Z01.00 OR Z01.01 as your diagnosis code INSTEAD of a code beginning with "H52". This is because many of Aetna's plans actually are set up to pay for routine eye exams but ONLY if the primary diagnosis is = Z01.00 OR Z01.01.
Please find a response written to one of our clients regarding the issue of billing Routine and Medical procedures to insurance companies on the same claim/ same date of service: