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Wiki Vuity eye drops

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schaunarae

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Location
Grand Forks, ND
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Hello! I bill and code for a small eye clinic and one of our doctors asked me today to find out more information on how other clinics are setting up visits for these eye drops? Just a regular visit that includes a pressure check and a follow up visit/pressure check at no cost?? I know you cant bill for a single pressure check as its included with an office visit. But what about a follow up pressure check? No charge?
 
Most offices on other billing sites are having patients pay out of pocket for any visits related to the Vuity, no billing to insurance. What I'd suggest is putting together a "package" fee which includes initial evaluation and 1 follow up pressure check. Charge appropriately. Don't give time away to these patients. Explain to the patients that the out of pocket fee covers the initial visit and one pressure check visit within 2 weeks of the first visit. Collect it all up front at first visit.

Tom Cheezum, OD, CPC, COPC
 
Hello, I was so pleasantly surprised that this topic was reflected here. I hope you will review the following and honestly/candidly let me know if proceeding with the following protocol (still in the discussion phase only) is acceptable for our coding of this new drug. BTW: We are a large optometry/ophthalmology group.
(1) Until insurances get a foothold on ways to cover Presbyopia treating drops (or decide not to cover due to the medication be elective and not a necessity) we will be charging patients a cash pay medical exam.

(2) For a previous patient that has a current Rx for glasses the plan would be to have them come in for a evaluation of pupils (photopic/scotopic), basic vision and IOP check, a full dilated fundus exam and making sure the patient does not have any allergies to the medication per Vuity prescribing information.
a. Exam would be billed as a 99213

(3) Patient would then return to clinic for a quick follow up in 3-4 weeks again with chief complaint and HPI's, checking pupils, basic vision and IOP.
a. Exam would be billed as a 99212

(4) If a patient is at the office for a routine vision/contact lens exam a discussion can begin on talking a little about the product and finding out if they would like to have further work up and evaluation to try the medication. a. Patient would then return to clinic at earliest convenience for the 99213 work up/exam.

(5) If patient has a current pair of glasses or contact lenses but their provider does prescribe Vuity. a. Code would of course be new patient 99203.

Your expertise, insight (and wisdom) would be greatly appreciated.
Best,
Diana Walp
CPC, COPC, CPMA
 
This looks like a very reasonable plan. This is what I'm calling a "vanity drug" so the patients should NOT be able to use their medical insurance or a vision plan visit to pay for these services. I'd be surprised if any insurer agreed to come up with a code to bill them for the services attached to Vuity.

From what I'm seeing on various provider on line bulletin boards, many patients are curious about this but, once they find out the cost of the visits to determine whether it's appropriate for them to use and the cost of the drops, most decline.

Tom Cheezum, OD, CPC, COPC
 
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