Advanced Search

Ophthalmology and Optometry Coding Alert

3 Steps Help Resolve 'Medical vs. Vision' Insurance Coding Mixups

Published on Thu Mar 04, 2010

When your patient has both types of insurance, who gets the bill? Let the reason for the visit decide. A patient presents for what you expect will be a routine vision exam, but then you find cataracts. Should you still report the service to the patient's vision plan or to his medical plan because the ophthalmologist found a medical problem? Or both plans? Follow these guidelines to ensure you don't get into hot water with your patient -- not to mention CMS. 1.Check CC and HPI for Clues Base your decision on which plan to bill on the reason the patient is in the office. The key factors are the patient's chief complaint (CC) and history of present illness (HPI). 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 [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Ophthalmology and Optometry Coding Alert

View All