Coding > Coding

Denial-0ptometry

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Michele:
It may just be that the doc doesn't realize he should be coding the complaint along with the reason.  Like you said, pt states "I have blurred vision and high blood pressure"  both should be on the claim.  The doc may think "well the blurred vision is due to the high blood pressure" and just put the high blood pressure.  Maybe education is the answer.

Pay_My_Claims:
Thanks Michelle, yes I notified him, and his partner and sent him the Medicare guidelines on it. HTN is factor in vision issues, but it is not a dx that I am currently aware of that Medicare allows as a reason for an eye exam. The only 2 that I know is for glaucoma, and diabetes.
thanks for everyones input

Michele:
They allow for alot more than that, diabetic retinopathy, dry eye, visual floaters, way too many to name.  We've been billing for OD's to Medicare for 15+ years.

Tilbrook:
I second Michele -- Medicare will pay for many more diagnoses than diabetes or glaucoma.  Our ophthalmologists bill Medicare for the majority of their patients.  You are correct that a medical diagnosis is needed, as Medicare will not pay for a routine eye exam.  Most insurance companies won't in fact.

Pay_My_Claims:
 @ Tilbrook Yes, and i wasn't saying they were the ONLY dx they cover for, but the guidelines that are automatically covered are for the diabetic yearly exam, and for history of glaucoma.  I was thinking I was correct when I emailed the optometrist that I needed a complaint dx that 401.9 did not justify medical necessity for payment on the claims.

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