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The Contact Lens Check?

Proper coding can help boost your bottom line.

JOHN RUMPAKIS, O.D., M.B.A.

It seems that for time eternal, the contact lens check has been part of the fabric of the optometric practice. But when is a contact lens check not a contact lens check? The answer is simple: When you are checking the eyes (structural examination, not refractive) of someone who wears a contact lens. Knowing the difference can make for more directed care, proper medical records, proper coding and increased profits.

What would you do?

Perhaps an example would help. Let’s say that you have a patient whom you fit for contact lenses a few months ago. The patient calls and says, “My contact lens is bothering my right eye.” How do you handle that?

Upon informal polling, I’ve found that most OD’s reply, “Well, because I just fit the patient a couple of months ago, I would schedule a contact lens check.” I then ask, “Do you charge for the visit?” Initially, their response is, “Of course I do.” But upon further questioning, they admit that they don’t because they feel bad that the patient is having a problem with the contact lens and generally will provide this service at no charge. One O.D. adamantly stated, “But I do try to upsell the patient to get some plano sunglasses instead!”

A Different approach

Let’s look at another approach that just might make more sense, both because it is consistent with medical care policies and would be appropriate by today’s clinical standards. On a philosophical level, the patient’s contact lens is not bothering him, his eye is bothering him AND he happens to be a contact lens wearer. The patient’s primary reason for the office visit would be pain, hyperemia, discomfort, etc. The fact that the patient wears contact lenses does not change the medical nature of the encounter.

Therefore, this visit would be coded for a medical office visit using either the 920XX or 992XX codes (using the most appropriate code based upon what was recorded in the medical record and meeting of the code definition) and billed directly to the medical carrier in accordance with the rules of the patient’s medical plan.

Yes, that means that you will be either collecting a co-pay or the patient may be paying out of pocket in order to meet his deductible. Nonetheless, whoever is the responsible party financially, this visit is generally a legitimate medical encounter and not a freebie that is built into an “annual contact lens care program.”

One caveat: Keep in mind that some managed vision care plans do require as part of their contract a single follow-up exam when the patient is initially fit or refit, generally within the first 30 days of billing the 92310 contact lens fitting code.

Bottom line

Contact lenses are a large part of most optometric practice revenue cycles. Providing services for free because of lack of understanding or mischaracterization of the reason for the visit is a common behavior and certainly a cause for loss of revenue.

Make 2014 your year to plug this hole in your cash flow revenue cycle and benefit from both the consistent and correct application of medical eyecare guidelines and a better bottom line as well. OM

DR. RUMPAKIS IS FOUNDER, PRESIDENT AND CEO OF PRACTICE RESOURCE MANAGEMENT, INC., A CONSULTING, APPRAISAL AND MANAGEMENT FIRM FOR HEALTHCARE PROFESSIONALS. E-MAIL HIM AT JOHN@PRMI.COM, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.