Ophthalmology and Optometry Coding Alert

Question: Should I charge a Medicare patient for a refraction (92015)?
      
Arkansas Subscriber

Answer: Regardless of whether a patient is on Medicare, if your physician performs a refraction (92015, Determination of refractive state), you should code and submit a claim for it.
 
Educate the patient to avoid collection problems. Some groups use inserts in statements, office handouts and flyers in the waiting room. Medicare considers refraction a non-covered service at all times and under all circumstances.
 
The patient is responsible for paying the service. As a non-covered service, refractions don't require an advance beneficiary notice (ABN), but you should inform the patient that refraction is non-covered and, as such, he or she will be responsible for payment.
 
When a patient who had a refraction checks out, charge him or her for it. You are not obligated to file a claim and wait for Medicare to deny it before collecting from the patient.
 
If you perform the refraction during a postoperative visit for cataract surgery, you may collect it. Or, as a sign of goodwill, include it along with other postoperative care (although you will not get paid for it, and most patients require several refractions after surgery).

 - Answers to Reader Questions and You Be The Coder were contributed by Raequell Duran, president, Practice Solutions, Santa Barbara, Calif.; Dennis Sandoval, MD, Eye and Facial Surgery of New Mexico, Albuquerque; John Bell, CEO, Maine Eye Care, Waterville.