Wiki 92015 To bill or not to bill...

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ashumack

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I recently started as a coding and billing specialist in a small optometry clinic. Previously I coded ER for a rural access hospital, and so I am not sure what the right thing is when it comes to refractions.

This clinic has historically been billing 92015-GY to Medicare and having the patient sign an ABN. I have spoken to a couple of other billers in Ophthalmology clinics who say they do not bill the 92015, but they still get the ABN signed and collect from the patient at the time of service.

Is it necessary to bill 92015 to any insurance in order to charge the patient for it if we are 100% sure that the insurance will not cover it because they consider it routine?

Thank you to anyone who can help!!!:cool:
 
I think you only need to submit the code and the GY modifier if other services that are covered took place on the date of service or if a formal denial is necessary to submit for secondary. I'm trying to remember if it's this or another modifier which is used when the patient insists the non-covered charge be submitted even though you know it will deny.
 
In my practice, we would submit the 92015 to Medicare or other major medical carriers without any modifier. We ALWAYS collected our fee for refraction at the time of the exam since 92015 is never covered by MC and very rarely by any major medical plan, whether primary or secondary. In the rare instance that the secondary plan did pay for the refraction, we would reimburse the patient. That happened maybe 2 times per year.

It's not really necessary to file the 92015 at all but we did it mainly to show patients that it continued to be a non covered MC service when they saw that on their EOBs.

Also, since it has never been a covered service by MC, it's not necessary to do an ABN with the patient. Personally, since it isn't a covered MC service, if you wanted to go to the trouble of having the patient sign any form for this, I would think an NEMB form would be more appropriate but still not necessary.

Tom Cheezum, O.D., CPC
 
You can charge the patient for any refraction you do. That being said, in most cases, the first refraction after a cataract surgery is usually done to see if the eye is healing in a way which will end up at the refractive goal set by the surgeon and isn't one which I would rely on for an eyeglass prescription.

I would just charge for the final refraction done about 3 weeks after surgery which should be a prescribable eyeglass RX.

Tom Cheezum, OD, CPC, COPC
 
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