Coding & Billing

Specialty Lens Coding for Insurance Reimbursement

Insurance coding is complicated and can be confusing and extremely time consuming. Here are a few suggestions to help:

1. Be sure your office has the current code books:

  • Diagnosis Codes

1 ICD-9-CM 2012ICD-9-CM

The current ICDN code book is dated 2012 and can be used until the end of September, but on October 1, 2015 the new ICD-10 codes go into effect and must be used. Be proactive and ensure the billing software your office uses will be able to incorporate these new codes.

2 icd-10-2014ICD-10-CM *MUST use after October 1, 2015*

There will be many changes, so   be sure your current office software will be compatible

Click here for a Quick Reference for the Top ICD-10 Optometry Codes

 

For ICD-10 resources see the following:

 

  • Procedure Codes

3 cpt2014CPT Level I Codes 2014

hcpcs cpt level II 14HCPCS (CPT Level II)

 2. Review Carrier Determination Policies: National Carrier Determinations (NCD) For Eyes found at: CMS.Gov NCD coverage determination search.

3. Local Carrier Determinations (LCD)

4. Review the contracts you have signed with insurance carriers so that you and your staff, are aware of the details.

5. Email the NKCF for current information about billing and coding.

6. Letter of Medical Necessity: Create a basic letter of “Medical Necessity” template on your office letterhead and modify it as necessary for each patient.

  • We are currently updating the Insurance Reimbursement Letter to send to your insurance company along with your bill. Please check back in a few days. 
  • Click here for a sample letter of Medical Necessity, courtesy of Dr. Clark Newman, OD, FAAO.

7. Explain Your Fees: Create an office brochure or just a simple one page information sheet explaining contact lens fees to discuss with your patients.