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coding for refraction with a medical visit

Arnkpc

New
Messages
7
Best answers
0
Every so often my office keeps running into this issue and I am not sure what is the best method to get reimbursement for all provided services. A patient will come in, typically they are elderly with a medicare and a supplement. They have some sort of medical issue with their eyes, diabetic ret, Cataract etc. These patient also want a refraction done so they can update their prescription. We explain that Medicare will not cover a refraction and that they will have to pay out of pocket for one. They explain that they also have a vision policy. And that creates the dilemma. If they didn't have routine vision coverage we tell them they need to pay out of pocket if they want the refraction. Medical insurance doesn't want to pay for the refraction. Vision insurance won't pay for medical visits. I would try and split it where the 992XX code goes to Medical and the 92015 code goes to vision, but I can't imagine EyeMed or VSP covering just a refraction not connected to an office visit. Any ideas on the best route to go? Do I send 992XX and 92015 to medical, get the denial for 92015 and then send a new claim with the first EOB to the vision insurance? any tips would be really appreciated.

Aaron Kopic CPC-A
 

MSCALLIE79

Networker
Messages
26
Best answers
0
VSP will cover as a 2ndary claim, I believe they have the guidelines for filing on there website.
 

Cheezum51

Expert
Messages
253
Best answers
0
VSP will do COB with medical. None of the other vision care plans will except with rare exception. Bill the medical exam and 92015 to Medicare and the supplement. Very infrequently, some of the supplement plans will pay for the 92015. If the 92015 is denied, then bill VSP per their on line instructions. Very often, if the patient had a copay for their medical exam, VSP will reimburse for some or all of that as well as the refraction.

Tom Cheezum, OD, CPC, COPC
 
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