Ophthalmology and Optometry Coding Alert

Question: In your article about glaucoma screenings last month, you noted that one of the main denial reasons for glaucoma screenings is that patients have already reached their benefit maximum for the time period. How can we verify whether patients have met their benefit maximum or not?

Codify Subscriber

Answer: If the patient isn't able to confirm the date of her last glaucoma screening, you should contact the insurer, such as her Medicare carrier, to ask when the patient last had a screening. Because glaucoma screenings for high-risk patients are only payable annually by Medicare, you must be sure that the insurer can verify that 11 full months have passed since the last screening was performed. If the patient did have a prior screening within the last 11 months, then it's likely that another screening within that period will be denied.