Aging Boomers = Profits for Your Practice

Thomas I. Porter, O.D., FAAO

Low vision care has never been fully embraced by the eyecare professions. The most commonly cited reason for this is economics. Low vision care must make economic sense for practices - few will provide it if they can use that same chair time more profitably elsewhere. Attention to coding, however, can help surmount this issue.

If the patient wasn't referred by another eye doctor, the first service required is a general ocular health and refractive assessment. The testing performed, the documentation, and the coding used should be much the same as for primary care patients. One exception may be the amount you charge for refraction (92015). Most low vision patients require a more time-consuming and complex refraction in a trial frame - and you can certainly bill this service at a higher rate. If you determine that a simple change in refraction won't improve the level of functional vision to a satisfactory level, then scheduling a separate low vision evaluation is a good idea. It's generally not advisable to include the ocular health assessment and low vision examination in one visit because of the time involved and level of fatigue the patient experiences.

Getting started

When a patient returns specifically for a low vision examination, many practitioners view this visit as a time to evaluate and determine whether low vision aids and visual rehabilitation will improve his/her functional visual skills. The practitioner sets specific visual goals and investigates solutions. Most successful practitioners code these visits using evaluation and management coding (E&M) because most specific low vision evaluations involve extensive patient counseling and education (a determining factor for code level in the E&M codes). Be sure to document face-to-face time as well as the percentage of the visit devoted to patient counseling and education. It is also recommended to use the level of vision loss as a primary code in diagnosis and the cause of vision loss as a secondary code.

If another doctor or agency sends a patient to you for a low vision consultation and evaluation, you may use what are known as the E&M "consultation" codes. Several requirements are necessary to bill using consultation codes. First, you must have a request for the consultation (document in the patient's record). Second, for a visit to qualify as a consultation, you must either give an opinion on a diagnostic unknown or on a mode of treatment with which the requesting doctor is not fully familiar or is unequipped to provide. Low vision services fit nicely into this second category. Finally, a written report to the requesting doctor or agency on the results of the patient visit is required. Consultation codes often provide the highest rates of reimbursement per hour.

Don't overlook training

Many primary care practices don't provide extensive low vision rehabilitation training. However, if there is a significant education component involved during the dispensing of low vision aids, then it's legitimate to bill using the E&M code 99211 for the time your technician spends with the patient (as long as supervision requirements are met). You should document this instruction in the patient's record.

Help them with daily living

Many low vision practices include training in the skills that are classified as activities for daily living (ADL). These services may be covered by the series of codes (97XXX), but they are subject to varying state regulations and insurance carrier policies. Depending on the carrier policy, physician extenders may provide these services according to the regional carrier's supervision rules. States vary as to whether an O.D. can write orders for these services. The services are billed in 15-minute units and are limited to six to eight hours of therapy, again depending on regional policies. Documentation is specific for these codes -always check your carrier's billing policies before choosing a treatment modality or method of coding.

Be prepared, be profitable

As the population of the United States continues to age, low vision care represents a tremendous opportunity to provide a service that will differentiate your practice from others in your community. To be successful, brush up on clinical skills and research the reimbursement policies for your region.

This article has been condensed from an article in the July 2003 issue of "Optometric Management."