Optometry Coding & Billing Alert

Published on Fri Aug 08, 2003 PDF

How one coder stopped denials.

Even though some carriers have finalized local medical review policies (LMRPs) for pachymetry, don't be discouraged if yours doesn't.

Hear how one coder turned the fact that her carrier did not have a finalized LMRP to her advantage.

Ellen Janney, CPC, of Valley Family Practice in Roanoke, Va., spearheaded her practice's efforts to get coverage for those "hateful pachys." Understanding that one of her carriers did not have an LMRP on pachymetry and tired of seeing her claims rejected, Janney and the physicians in her practice wrote the director and sent articles and study findings - everything they could get their hands on - to prepare the committee members for an advisory meeting taking place this summer.

If your carrier doesn't have an LMRP in the works, get in contact with your local Medicare-carrier personnel. Try contacting the director or an optometrist on the advisory committee to push the issue.

Find out where your carrier is in the development of a policy outlining the uses of pachymetry for glaucoma diagnosis and treatment. Some local Medicare carriers and private insurance companies have already posted LMRPs, updates, or bulletins that outline their pachymetry reimbursement policies. Review these documents carefully, making sure you note effective dates and any other requirements.