Contact Lens Spectrum Supplements

Special Edition 2017

Contact Lens Spectrum

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C O N T A C T L E N S S P E C T R U M S P E C I A L E D I T I O N 2 0 1 7 c l s p e c t r u m . c o m 58 CODING M astering the science and art of fitting specialty contact lenses requires constant at- tention to new research and emerging techniques and technology. For example, our rapidly evolving under- standing of scleral shape, settling of vaulting lenses, oxy- gen transmission through a post-lens tear reservoir, and countless other details is contributing to our success with hybrid and scleral lenses. Maintaining our status as ex- perts in this area requires constant review of the literature, demonstrated understanding of multiple lens modalities, and experience with complex ocular conditions, as well as equipment and devices built specifically for managing patients with complex anterior segment needs. Expertise in one more critical area is necessary for a successful specialty lens practice. You and your staff must understand how to bill and code properly for this special- ized care — or risk a scenario similar to the following. HAS THIS HAPPENED TO YOU? After seeing his patient's astigmatism progress over a few years and checking topography and pachymetry, Dr. Doogood diagnosed the daughter of a long-time pa- tient with keratoconus. He felt confident that custom soft toric lenses that correct for high cylinder would be successful for the patient. Feeling sorry that he had to report this diagnosis to the patient's parents, Dr. Doogood reduced his fees and billed Eyemed for a general exami- nation and contact lens evaluation. At the dispensing visit, the patient's visual acuity with the custom soft toric lenses was 20/40 in each eye. Dr. Doogood knew he could achieve better vision with gas permeable (GP) lenses, but prescribing GP lenses placed him in a difficult position. The fees billed were not meant to cover multiple visits with trial lenses and troubleshooting. Being a great doctor, instead of telling the patient that this was the best vision she could achieve, Dr. Doogood took time from his busy clinic to fit her with corneal GPs. At the next dispensing visit, the patient's visual acuity was 20/20 with the GP lenses, but she reported they were uncomfortable. She decided to continue wearing the lens- es, but within a few days, she called Dr. Doogood to report that she could not adapt to them. He brought her back for a trial of piggy-back lenses. Although the patient said the comfort was much better, she called the office a few days later to report that the lenses dislodged three times a day. Dr. Doogood knew he could solve this problem with a hybrid lens, so he scheduled a return visit … and so on. If any of this story sounds familiar, please keep reading. WHAT WENT WRONG Multiple failures occurred on multiple levels. First, when a doctor does not bill and code appropriately for his or her services, both parties become upset. It is human nature. The growing divide between expectation and reality leads to unhappiness. The patient was not prepared for multiple visits, because up until now, the doctor always got her contact lenses "right" on the same day. The doctor now sees the patient as a problem at each subsequent unplanned visit, and tensions rise. Next, by definition, a patient with keratoconus cannot be coded as a general patient, because the most accurate code that describes the service provided must be used. In this case, the contact lens evaluation must be coded as 92072 (fitting of contact lens for management of kerato- conus, initial fitting) and not 92310 (prescription of opti- cal and physical characteristics of and fitting of contact lenses). Therefore, Dr. Doogood violated his contract with Eyemed, which would likely be revealed in an audit. H er e ' s h o w to e n s u r e a ppr o pr i a t e r e i m b u r se m e n t f o r t h i s p r o fe s s i o n a l l y r e w a r d i n g e n d e a v o r BILLING AND CODING FOR SPECIALTY CUSTOM CONTACT LENSES J E FFR E Y S O N S I N O, O D

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