Client Response

Please find a response written to one of our clients regarding the issue of billing Routine and Medical procedures to insurance companies on the same claim/ same date of service:

Dear Dr. "X",

 I have noticed many, many times that when you are working with patients who have both an eye exam and vision therapy session that you are coding the entire visit as routine. This is not correct and puts us at a bit of a disadvantage here.

 It is important to note that :
92060 is NEVER covered when paired with ANY diagnosis that begins with "H52".
It is also important to NEVER include a diagnosis beginning with 'H52" in the chart of a patient who is receiving vision therapy. The reason for this is that even if you don't link the patient's procedure code to that routine diagnosis, compulink still does when creating claims. The best thing to do is to just leave the routine diagnosis out of the chart completely.
If a patient has a benefit for both routine exams AND vision therapy sessions, I strongly advise against performing both a routine exam and a vision therapy session on the same day. Many commercial payers, such as Cigna, utilize the services of foreign workers to adjudicate these types of claims and they are notorious for automatically denying valid medical claims if they even contain a routine diagnosis code on them (in fact I advise NEVER performing routine and medical procedures during the same session for the same reason) . I can not say for certain if this is due to language barriers when they are receiving their training or if they are given explicit instructions by the corporate office to make these decisions, however, the end result, 99% of the time, is that the entire claim ends up getting denied as routine even though it was most likely coded correctly. Getting this decision reversed is harder than having a letter you sent to the President of The United States personally replied to by him instead of one of his staff members.

 As always, I hope you find this information both helpful and informative. Please share it with any colleagues you deem necessary. You can also direct them to read our blog for similar information as well.