Medicare Guidelines to Follow for Optometry Practice!! - PowerPoint PPT Presentation

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Medicare Guidelines to Follow for Optometry Practice!!


As a busy optometrist, you need to be thorough with the current procedural terminology (CPT) codes that are used for reimbursement in Medicaid and Medicare.  – PowerPoint PPT presentation

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Title: Medicare Guidelines to Follow for Optometry Practice!!

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Medicare Guidelines to Follow for Optometry
As a busy optometrist, you need to be thorough
with the current procedural terminology (CPT)
codes that are used for reimbursement in Medicaid
and Medicare. A successful optometrist will need
to be conversant with codes falling under the 92
and 99 series so that problems with reimbursement
are avoided. Moreover, you need to be wary of the
watchful eyes of the Health Care Financing
Administration (HCFA), the watchdog that looks
out for any sort of misuse. Use the Correct
Code The code usage will generally depend on
what transpires when you see a patient, the time
you assign and spend with the patient, and of
course, how well the time was spent. If it is
just a cursory or even detailed eye exam, with no
medical care or any sort of counseling, you need
to be using 92 series codes. However, if you do
follow that up with counseling, then you need to
be using the 99 series codes, though caution is
advised while using 99 series codes. Only a
seasoned practitioner with a high level of
medical expertise should venture into using 99
codes as they require precise documentation at
every stage, which is where most optometrists
face problems. Whenever you are unsure, it is
safer to use 92 series codes while billing.
Medicare Guidelines to Follow for Optometry
For Diabetic Patients A regular annual check-up
for a patient with chronic diabetes would involve
performing a dilated fundus exam, though in
reality there is nothing special or different
that is done while examining/treating a diabetic.
However, an experienced optometrist would
carefully scrutinize the retina for tell-tale
signs of microaneurysms and/or early stages of
retinal edema. As this is an eye exam, it would
qualify under 92014 for billing
purposes.   Refractions though, need to be billed
separately under code 92015 as refractions are
classified as separate procedures, hence
different from examinations according to the new
rules. A word of caution As annual denotes
routine, and since Medicare does not make
payments for routine care there may be a legal
hurdle for reimbursement. Follow-ups for
Diabetic Patients A follow-up will depend on the
clinical findings and may be required if any blot
hemorrhages are noticed or retinopathy is
detected in the background.
Medicare Guidelines to Follow for Optometry
In such cases, a follow-up after 6 months may be
required. The follow-up should also include
checking the patient's diabetes parameters like
stability on insulin etc. The billing would be
92014 this time as well. However, if diabetic
retinopathy is detected during follow-up, the
code that needs to be used is 99214. This is
because it is more medical care as it involves
counseling and advice on medical problems and
qualifies as a level 4 office medical
visits. For Cataract Patients The
above-mentioned points would apply for cataract
patients as well. There are specific instances
like a patient with a mild cataract who could be
pseudophakic in the other eye. In such cases, the
codes to be used are 92014 and 92015 as it
involves an eye examination and refraction. A
patient with a cataract would need a follow-up
only after a year or so as it is just minimally
symptomatic. However, a patient with a cataract
in one eye and who also is pseudophakic in the
other needs follow-up after 3 months or even 6 or
12, as the case may be. For Glaucoma Patients
Medicare Guidelines to Follow for Optometry
Glaucoma patients need to have the intraocular
pressure (IOP) checked every quarter or once in 4
months. As the optometrist just does a pressure
check and offers counseling on medication it
qualifies as level 3, and maybe level 4 medical
office visits at times. The code to be used for
this again is 99213 and 99214. However, if a
patient comes in for a regular quarterly check-up
and the optometrist finds that the vision has
changed this could mean an eye examination and
refraction, which is quite rare
though. Optometry is prone to exposure for
malpractice during such times as glaucoma can be
easily missed and follow-up is not done, often
leading to serious issues like loss of vision.
With patients' pressures fluctuating, a visit
every two months is necessary to maintain
stability. If any deterioration is detected, the
optometrist needs to refer the patient to a
specialist immediately. In conclusion, it can be
assumed that optometrists need to use office
visit codes according to Medicare regulations as
they are licensed to do so. Medicare classifies
optometrists as physicians based on the services
they provide. Hence, any services other than ones
relating to specific refraction like ocular
disease and its management justifies the use of
these codes. To know more about our optometry
billing and coding services, contact us
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