Reimbursement Revisited

By: Dr. Thomas Porter

At almost every meeting I attend the subject of coding, billing and reimbursement for low vision examinations and services comes up.  There is certainly a lot of confusion and many differing opinions about the best way approach this issue.

Ask Yourself Some Questions: 

Always first determine where the patient came from?  If they are current patients of the practice and have just “graduated” into the low vision arena then all coding will involve established patient codes.  If they are new to the practice, then were they self referred or sent to you by another doctor or agency?  Self-referred patients are coded much like any new patient to the practice.  You would probably first evaluate and use appropriated coding as you would any other new patient.  If patients were sent to you by an agency or another health care professional then you may be able to meet the criteria for a consultation visit?

When a patient returns specifically for a low vision examination or return for further evaluation specifically in low vision 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. Many 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). These are also the most common codes used for the various follow-up visits that are common in low vision care.  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. 

What About Training?

Certain professionals can bill Medicare and other third party payors successfully for training as related to the use of adaptive equipment in activities for daily living.  These codes are in the 935xx range.  At this time their use is limited to occupational therapy, physical therapy and physicians personally providing the services.  At this time physician extenders, technicians, and certified low vision therapist cannot bill universally under these codes.

Other Revenue Sources:

Don’t overlook the obvious.  Low vision aids represent a large portion of the income stream required to maintain a low vision practice.  Multiple low vision aids are the rule, not the exception.  Many times low vision aids are compared to tools for a carpenter.  Each tool has a specific job and each is necessary to “build the house.  In recent years electronic magnification has become more of a “main line” solution to many low vision problems.  Many successful practices are becoming involved in the dispensing of electronic magnifiers as a routine part of the services offered.