Tips To Get Adequate Reimbursement for These Services

Even small practices are expected to have a Humphrey visual field analyzer. But then, many optometrists are not aware of the secrets for securing ample reimbursement for these services - and they even go far as to put themselves at risk for costly audits owing to lack of documentation.

Stop shortcharging yourself with intermediate codes

CPT lists three different vidual field examinations - the higher the code, the higher the reimbursement: 92081, 92082 , 92083.

Snag: A common error optometrists make is billing 92082 when they could legitimately bill 92083.

The key to selecting the proper VF code is the code descriptors themselves. For instance, if you plot only two isopters on the Goldmann perimeter, CPT would call that “intermediate," based on its description of 92082. But then if you plotted three isopters, that would be an 'extended' examination that would qualify for 92083.

Rule of the thumb: An intermediate test is one of the screening tests that you'd go for if you suspect neurological damage. However optometrists use the threshold exam (92083) when they suspect something that causes a slow, progressive dimming of peripheral vision, such as glaucoma.

Glaucoma causes a loss of vision like a light bulb slowly becoming dimmer and dimmer, while trauma often leads to sudden, complete loss of central or peripheral vision. In screening fields, you're testing whether the retina is 'on or off', while in threshold testing you are testing 'how dim a light you can perceive.'

Document now to save yourself the trouble later

When you send in a CMS-1500 form, Medicare only sees the front part of the form. What Medicare does not see is what's on the other side of that form, which is your documentation. They take it that your documentation is correct until they do an audit.

If Medicare does an audit and finds that your documentation is not in order, you could land yourself having to pay them back for all the claims they find problems with. That is why it's vital to carefully document the medical necessity of the visual field exam in the patient's medical record.

For further detailed information, sign up for a medical coding guide like Supercoder.