Ophthalmology and Optometry Coding Alert
Medicares Routine Services Policy
The coverage of services rendered by an ophthalmologist is depending on the purpose of the examination rather than on the ultimate diagnosis of the patients condition. When a beneficiary goes to an ophthalmologist with a complaint or symptoms of an eye disease or injury, the ophthalmologists services (except for eye refractions) are covered regardless of the fact that only eyeglasses were prescribed. However, when a beneficiary goes to his/her ophthalmologist for an eye examination with no specific complaint, the expenses for the examination are not covered even though as a result of such examination the doctor discovered a pathologic condition.
Ophthalmology and Optometry Coding Alert
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Cyst on Eyelid
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The following is an excerpt from the routine services policy for Medicare:
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Photodynamic Therapy
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Astigmatism
Question: What is the criteria for payment by Medicare for correction of a surgically induced [...] - Reader Question:
Entropion
Question: We are getting denials from Medicare when we use the code 374.00 for an [...] - Reader Question:
Hospital Visit
Question: The ophthalmologist makes a follow-up visit to the hospital. It is for an established [...] - Reader Question:
Hydroxy Apatite Implant
Question: What is the HCPCS code for hydroxy apatite implant? Usually the hospital bills for [...] - Reader Question:
Standby Service
Question: The doctor is required to be present in an operating room when an ocularist [...]
