Whether you’re an optometric assistant or specialist doing optometry billing or an optometrist conducting the medical coding, it can take years to master this skill.
According to Eyes on Eyecare, many optometrists do not get this training in optometry school, and learning on the fly is not a realistic option. To get the necessary education to become competent in billing and coding, we’ve put together a list of the recommended continuing education courses and resources.
Importance of Billing and Coding
Billing and coding are important functions in an optometry practice. Errors in billing and coding can lead to delayed, denied, or partial reimbursements. Further, as Medicare reform continues, optometry practices are susceptible to audits.
The most common billing and coding mistakes include the following:
- Miscoding routine versus medical exams: The level of decision-making is different in a routine visit as opposed to a medical exam. The critical factor in coding the visit correctly is to consider the chief complaint.
- Using modifiers incorrectly for medical insurance claims: Modifiers are a double-edged sword. They are essential for a medical biller to include in order to explain all of the services provided in a visit, but mistakes here can result in an outright denial of claims.
While there are numerous modifiers used in an eye exam, the most common an optometry practice will encounter are the following four:
- RT/LT and E1-E4 to designate the right and left eyes and parts of the lids
- -24 is used for unrelated procedures administered during a visit, and this code must be used to get reimbursed from a vision insurance company
- -25 is used for unrelated procedures performed on the same day
- -55 is designated for post-op care where another surgeon did the original procedure
- Improper credentialing: This issue is related to timing. Before submitting claims to vision or medical insurance, make sure you have determined your business structure (sole proprietor, corporation, etc.), and that you are approved by the insurance panel.
Optometry Billing and Coding Education
Ensuring your optometry practice gets compensated adequately for the patient care provided is essential for the long-term success of your clinic. Further, avoiding an audit is another powerful motivator for becoming a skilled billing specialist. An audit can result in having to refund overpayments, and if the auditor detects fraud (even if it was inadvertent), it could lead to substantial fines and even jail time.
One of the best ways for medical professionals to build their skills in billing and coding is through university-affiliated continuing education classes.
The following universities currently provide education on topics related to health care, medical insurance, and optometry:
- Ferris State University: Pain, pharmaceutical, and practice management
- Western University: Currently 40 courses available
- Indiana University: Optometric Compliance
- Southern New Hampshire University: CE credits for certified nursing assistant and other nursing positions
- Ohio State University: Course access is available with an account
- New England College: Low vision rehabilitation strategies
- Salus University: Various programs ranging from standalone courses to competency-based programs
Attending live events is another great option for doctors and support staff. Modern Optometry Live is an annual event that addresses common questions in the field of optometry, including:
- Proper billing and coding procedures
- Avoiding billing errors (including underbilling)
- Learning the processes and paperwork involved in credentialing
- Determining whether it’s worth opting into Medicare
- How to set fees
- Practice recommendations from the American Academy of Ophthalmology and the American Optometric Association
Certifications and Training for Staff
The American Optometric Association (AOA) is also a valuable resource for optometry billing and coding classes for optometric practice staff members. The organization offers a paraoptometric certification consisting of four different levels, from entry to specialty.
The top-level certified paraoptometric coder distinction is designated for those who have demonstrated “superior knowledge” as a coding specialist.
The other levels provide education about health care issues and specific patient care diagnoses, including:
- Understanding medical terminology and ocular anatomy
- Perfecting the eye exam
- Administering vision therapy
- Having a contact lens practice
- Diagnosing and treating common ocular disease conditions, including binocular vision
The eligibility requirements include having a high school diploma and a minimum level of experience in a clinical optometry setting, ranging from six months to two years. An optometry degree is not required.
The AOA also offers a wide variety of courses and resources related to optometry billing.
Another helpful resource for billing and coding training is CMS (Centers for Medicare & Medicaid Services). A “medical billing” search on this government website leads to 38,000 results sorted by relevance. You can sort your search by date to see any changes to billing requirements.
If you’re looking to expand your optometric education and don’t want to pay the hefty cost of continuing education credits, Weave provides free CEs.
To earn CE credits, watch an engaging and informative video and pass a short quiz. Weave currently offers 24 opportunities to earn credits in the following areas, with more being added regularly:
- Optometric practice marketing and operations
- Practice management
- Business insights
Billing and Coding Basics and Resources
Need a quick refresher before you enroll in a medical coding or billing class?
We’ve put together a brief overview of basic billing and coding procedures that you can bookmark and reference whenever you need assistance.
Short for Current Procedural Terminology, this coding language provides a universal standard for healthcare professionals to ensure uniformity in documenting medical services and procedures.
At first glance, some CPT codes can appear to overlap, so a basic understanding of how they’re structured can help avoid confusion.
Eye care CPT codes include 92xxx and 99xxx codes. The “92” distinction is reserved for eye doctors, and they’re allowed for both routine and medical visits. “99” codes, on the other hand, are available to all healthcare professionals.
The most frequently used 92 CPT Codes are:
- 92004: An examination that includes a treatment program with one or more visits for a new patient
- 92014: Similar to 92004 but for existing patients
- 92002 and 92012: Typically used for follow-up visits
- 92250: Retinal photography
- 92083: Visual field examination
Optometry Procedure Codes | ICD-10
ICD-10 stands for International Classification of Diseases, Tenth Revision. These codes are meant to track public health conditions and contribute to secondary medical research. It is a requirement for any patient covered by HIPAA and includes up to thousands of diagnosis codes. The codes can change regularly, and being up to date is critical for accurate billing.
The latest ICD-10 codes are available here, with the last update published in October 2022.
The most common modifiers in billing, discussed above, will serve an optometric practice well, but it’s also important to realize that new modifiers may be added at future dates.
As the term suggests, modifiers are added at the end of a CPT code, delineated by a hyphen, to indicate additional details about a procedure.
The medical field changes so rapidly that staying on top of new developments can feel like a full-time job. Weave provides optometrists and medical billing staff with valuable, free resources to keep your knowledge up to date.
And, with Weave’s practice management system, you’ll have more time and less stress to focus on doing what you do best. Weave’s suite of tools assists with collecting payments, scheduling patients, and even marketing. To see Weave in action, schedule a demo.