coding & billing
The Value of Our Services
Don't leave money on the table by underestimating your expertise.
BY CARLA J. MACK, O.D., F.A.A.O.

Some eyecare practitioners (mostly optometrists) don't see the value of the services that they provide. In many cases, optometrists are primary eyecare experts providing more than primary eye care. Our value isn't only our prescription products such as spectacles and contact lenses, it's also in the diagnosis, treatment and expertise that we provide. Grasping this concept will translate into changes in your billing and coding practices that will have a positive impact on your practice's bottom line.

Battling expectations

A recent survey by Cleinman Performance Partners Inc. reports that the average optometrist leaves $100,000 of medically necessary and legitimate charges on the table each year. It's no wonder our patients have the perception that their office visit will be "free" or "no charge."

I personally have never scheduled an appointment with my dentist, primary care physician or a specialist and assumed that I would receive their care for free. Never. However, optometrists battle this expectation on a daily basis with patients. Why is this? Is it because there's a retail aspect of what we do or because we bundle visits together under one fee?

An incomplete education

Optometry students today are blessed with learning the top-of-the-line ophthalmic instrumentation in all of the schools of optometry, even though many may never see such instrumentation in their own practices. Yet in many cases, they haven't been educated on the value of their services, nor has their education included instruction on how to properly bill or code for the high quality of care they provide.

Optometrists show a lack of understanding of the complete circle of patient care (patient history, patient examination, thought process and decision making, medical record documentation, and coding and billing). Numerous references are available for determining the appropriate level of service provided and the proper procedure code. We all know practitioners who bill a level 2 for most medical visits and ignore additional applicable procedure codes simply because it's easier, safe and requires no additional investment of time, thought or patient discussion.

Think of it this way

When I receive a medication from my primary care provider (PCP) and it causes hives or doesn't resolve my complaint, I return to my PCP for re-evaluation and expect to pay for the additional services rendered that day as well as for the new medication he prescribes. Let's look at this differently: I prescribe a spectacle prescription that I determined for a patient from a comprehensive eye examination. The patient doesn't adapt to the prescription for any number of reasons.

Do I bill for the additional chair time it takes to evaluate the complaints and prescribe a new spectacle prescription? Or do I bundle this new unexpected complaint and additional service under the original comprehensive eye examination fee? Do I bill the patient for a spectacle lens remake or do I eat the cost? Is there a difference between the two scenarios?

When the patient returns

Consider the newly adapted and successfully fit contact lens wearer who presents to your office with a red eye, regardless of the cause. Do you bill the appropriate medical evaluation and management (E&M) code or do you provide your service and your knowledge at no additional cost to the patient, considering this part of the patient's previously paid contact lens professional fee?

I've had patients try to return opened boxes of lenses and worn contact lenses to my practice on many occasions for any number of reasons. How often do pharmacists have customers bring opened prescriptions back demanding a refund or demanding that the medication be exchanged for the newly prescribed medication? I believe you should charge appropriately for these services just as the PCP or pharmacist would.

It's all a matter of perception

Do patients view your practice as a place that sells products or do they perceive your office as providing high quality eye care with high quality prescriptive medical devices? I recommend that you and your staff get educated on proper coding and billing and find a coding reference that works for you. Once you have a better understanding of these matters, you'll be better prepared to educate your patients about your diagnosis and treatment capabilities.

It's also helpful to look at how you bundle services and visits under one code and sort out what you should bill separately. For example, if you determine that you need threshold visual field testing from your comprehensive eye examination findings, then the patient's return visit should be a separate billable medically necessary E&M code with a medical diagnosis code, along with the threshold visual field procedure code.

Finally, seek out examination forms and super bills or service sheets that contain all of the necessary procedure and diagnosis codes needed to code efficiently.

Starting with you

Of course some practitioners already get it -- already understand the value of the high-quality patient care they provide and who bill for their services appropriately and have patients who respect their time and expertise. I hope these scenarios will make you think about your own perception, as well as your patients' perceptions, of the expertise and quality care that you provide.

DR. MACK IS CLINICAL ASSOCIATE PROFESSOR AND DIRECTOR OF CLINICS AT THE OHIO STATE UNIVERSITY COLLEGE OF OPTOMETRY. REACH HER AT MACK.58@OSU.EDU.