Ophthalmology and Optometry Coding Alert

Even though some carriers have finalized local medical review policies (LMRPs) for pachymetry, dont be discouraged if yours doesnt.

Hear how one coder turned the fact that her carrier did not have a finalized LMRP to her advantage.

Ellen Janney, CPC, of Valley Family Practice in Roanoke, Va., spearheaded her practices efforts to get coverage for those hateful pachys. Understanding that one of her carriers did not have an LMRP on pachymetry and tired of seeing her claims rejected, Janney and the physicians in her practice wrote the ophthalmologist specialist and the director, sent them articles, the OHTS findings, everything they could get their hands on to prepare the two committee members for an advisory meeting taking place this summer.

If your carrier doesnt have an LMRP in the works, get in contact with your local Medicare carrier personnel. Try contacting the director or an ophthalmologist on the advisory committee to push the issue.

Find out where your carrier is in the development of a policy outlining the use(s) of pachymetry for glaucoma diagnosis and treatment. Some local Medicare carriers and private insurance companies have already posted LMRPs, updates or bulletins that outline their pachymetry-reimbursement policies. Review these documents carefully, making sure you note effective dates and any other requirements.