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Wiki Routine Eye Exam vs. Medical

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alibertini

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If a patient comes in for a routine eye exam but the provider finds a medical diagnosis, as a coder I am trying to find backup that shows that unless we treat the patient for said medical diagnosis, we must bill to the vision insurance. Example: Patient comes in for yearly routine visit and provider sees benign growths on bilateral lids. Provider mentions to the patient he can go to an ocular plastic surgeon to have them removed. Provider also find the beginning stage of cataracts. Is there anything I can print that shows we need to bill this exam to the vision insurance because of the patient's reason for coming in, that we cannot decide to send to medical insurance even though we do have medical diagnoses? As coders and A/R reps we understand this... how do we help providers understand? :confused:
Thank you for your help!
 
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