Optometry Coding & Billing Alert

Question: We keep getting denials on certain codes from certain payers. The optometrist says we should just stop billing the codes that our payers never reimburse us for, even when they are the proper codes for the procedures he performs. Is this so?

Arizona Subscriber

Answer: If there is a CPT code for the procedure your physician performs, you should always bill that procedure code. Even though your payer isnt paying you on a code, that doesnt mean you should stop reporting it.

By reporting a code, youre not only correctly portraying the services your optometrist performed, you are also showing the payer that the code is getting used.

Eventually, if enough optometrists are using a code, a payer may assign a value to it and begin reimbursing you.

Plus: If you stop using a code, and so does the rest of the optometry community, CPT may eventually delete the code assuming that physicians dont use it.

-- Answers to You Be the Expert and Reader Questions reviewed by David Gibson, OD, FAAO, practicing optometrist in Lubbock, Texas.