Ophthalmology and Optometry Coding Alert

Question: We have a longtime patient who we have recently been seeing for a new workers comp disability claim (due to a chemical spray into his eyes) as well as for his existing (Medicare-insured) issues. Our billing company informed us that we cannot see this patient for both personal and workers- comp problems on the same day. The billing company said that the person should set up an appointment one day for worker- comp and another day for the Medicare visit. Would it be acceptable to have the patient leave and then come back in an hour or in the afternoon? Also, does the ophthalmologist need two charts for each insurance and, therefore, two sets of progress notes?

Texas Subscriber

Answer: Your best bet is to ask your outside billing company what its source was for its belief that you can’t collect for both visits and that you have to ask the patient to return another time for the second visit. Neither the Medicare website nor the OIG website appears to substantiate this statement. It is true that you cannot bill a workers compensation insurer for services that are rendered for non-work-related claims, but many people do see their own existing physicians for work-related injuries.

For example: Suppose the physician sees a patient for an eye injury that occurred on the job, but during the same visit also tweaks the patient’s glaucoma medication. Because the different exams are separately identifiable, you should be able to report both to their respective insurers. It is important that the two services not overlap and that the elements counted in one service do not get counted toward the other.

Therefore, many coding and billing analysts recommend that you maintain two completely separate charts each with separate notes — one strictly devoted to the work injury and the other strictly devoted to non-work injury details and information.

In addition, the ICD-10 codes that you select for the different services must reflect the work the physicians did to treat the patient’s separate problems.