Optometry Coding & Billing Alert

Published on Thu Dec 08, 2016 PDF

Diagnositic tests may not boost revenue, but they have other benefits.

Insurance reimbursements for dry eye treatments are actually increasing, Whitney Hauser, OD told attendees at Vision Expo East earlier this year. And the condition is so painful and life-altering that many patients are willing to spend out-of-pocket for premium elective procedures that bring relief, Hauser added.

Don’t expect diagnostic tests to bring in much revenue. Most tests aren’t separately billable from the office visit. “I don’t use diagnostic testing to get rich — I use it to get information,” Dr. Hauser says. Test results help clinicians solve the patient’s problem, and high patient satisfaction always boosts your practice’s bottom line.

Medicare and other payers will reimburse for some dry eye treatments, such as punctal plug insertion (see https://www.aapc.com/codes/coding-newsletters/my-optometry-coding-alert/dry-eye-plenty-of-dry-eyes-in-the-house-heres-how-to-safeguard-your-reimbursement-149934-article).

When Medicare and other payers won’t pay for therapies to treat dry eye, many patients are happy to pay out-of-pocket for treatments that offer more effective, time-saving alternatives to warm compresses, which are sometimes recommended for melting and expressing the hardened oil that clogs the meibomian glands and causes dry eye.

A basic treatment for meibomian gland dysfunction (MGD) is a beaded warming mask, which wholesales for $12.50 and retails for $20, Hauser says.

Meibomian gland probing costs between $80-$200 per treatment. Lipiflow costs the patient much more because of the investment the physician must make in the equipment, but prices are coming down.

For dry eye associated with blepharitis, therapies like BlephEx can “wipe the slate clean” of demodex so you can then follow up with more traditional therapies like tea tree oil, Hauser notes. Most practices charge between $150 and $200 for a BlephEx treatment.