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optometrist

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margemib:
hi Michele,
I spoke to a optometrist office manager today that is thinking of changing billers, I remember you saying this type of billing is the same as any medical billing. But I was thinking how does this work with eyeglasses and so forth?
Please tell me what I need to know that would help before before she calls.
margemib

Pay_My_Claims:
it varies per visit. I can come in for a routine eye exam, and they determine I have glaucoma, the visit now turns to medical. I can come in for a routine eye exam and have UHC, but my vision benefits are with VSP. *you can still have an exam with uhc too*. When you bill for contact lenses/glasses you have to determine the benefit. ex: a client can have 200.00 limit on contact lenses/frames but also a limit on the #. You can have a sale on frames $50.00 the client has a 200 max benefit, but can still only get 1 pair of frames per calendar year. Also Medicare doesn't cover unless its a medical exam. They don't cover the refraction...there is a lot to optometry.

Michele:
The codes for lenses and frames are just HCPC's and the provider will give them to you.  V2020 for frames, V2100 for single vision, etc.  There is a little to learn, but don't let it scare you.  It is different is many ways, but it is also cpt & icd9 codes. 

Michele

Pay_My_Claims:
Sorry but thats not accurate. I worked in optometry and the billing is very different. The frames and contact lenses may be cut and dry, but the rest is different. They also have pqri reporting etc that is done in the billing. One big difference is knowing if you are billing for a medical as opposed to a vision benefit. There is global billing with optomety. OUr optometrist also did lasik and she performed visual fields, and also did surgery in a DAC. Optometry is not cut and dry with very little to learn.

PMRNC:
I'm with Charlene on this one. Also Ophthalmology vs Optometry are different...both are tedious to bill out and a lot rides on the proper coding, benefit verifications, pre-determinations, etc.

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