Ophthalmology and Optometry Coding Alert

Question: We regularly have patients who don't show up for their appointments and don't tell us in advance that they will be unable to make it, which means we can't schedule another patient in their place. Is there a code we can report for these no-shows, and can we get paid for the inconvenience?

Florida Subscriber

Answer: No, there is no CPT code - or applicable modifier - for a no-show, and your insurance carrier will not reimburse you for a service that you didn't provide. But there is a way to collect for these inconveniences if you know the ropes.

Most HMO insurance companies include in their contracts that you can only charge a patient for a visit - or even a copayment - if the patient presents to the office. One way to get around that is to write in your contract that you are not going to treat the HMO patients any differently and that you have practice protocols in place that state, "Above and beyond insurance carriers' contracts, we may charge patients if they do not show up for a visit without notifying us XX hours in advance that they will not be able to make it."
Warning: You must give the patient a copy of this no-show policy, and the patient must sign a statement saying he is aware of this policy for you to be able to legally collect a fee for a no-show.

Remember: You're not going to charge the insurance company when a patient skips out on an appointment. Instead, you must charge the patient.