Results 1 to 17 of 17

Thread: Pregnancy related Vision Codes

  1. #1
    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
    Join Date
    May 2001
    Location
    United States
    Occupation
    Dispensing Optician
    Posts
    3,197

    Pregnancy related Vision Codes

    I am looking for a list of insurance billing codes for changes in vision do to pregnancy. I have spent some time searching in my code books and on the web with no luck.

    I am hoping someone in Optiboard land has a list we can utilize.


    Thanks!
    Cassandra
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland

  2. #2
    Master OptiBoarder
    Join Date
    Oct 2006
    Location
    Michigan
    Occupation
    Dispensing Optician
    Posts
    2,827
    I may be wrong but I don't think there is anything specific. Can you use something else?

  3. #3
    Banned
    Join Date
    Jun 2000
    Location
    Only City in the World built over a Volcano
    Occupation
    Dispensing Optician
    Posts
    12,996
    My God! Now we are looking for a way to bill for everything. There is nothing you can do but observe vision changes in pregancy. Nothing you can do for it, so why even bother to examine?

  4. #4
    Master OptiBoarder
    Join Date
    Feb 2007
    Location
    NC
    Occupation
    Dispensing Optician
    Posts
    3,951
    Trying to get paid for a re-do?

  5. #5
    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
    Join Date
    May 2001
    Location
    United States
    Occupation
    Dispensing Optician
    Posts
    3,197
    OR working with Medicaid patients who have pregnancy coverage that in order for them to pay us for anything visual wise (like blurred vision, with headache, etc) require us to use a code specific for pregnancy.

    While it is a known fact that pregnancy often bring about vision changes, we do not simply write it off as such without at least an exam to make sure there is nothing else going on.

    I have had a handful of claims denied over the past year between two offices do to this type of situation. It would be nice to receive payment for our services.
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland

  6. #6
    Master OptiBoarder
    Join Date
    Oct 2006
    Location
    Michigan
    Occupation
    Dispensing Optician
    Posts
    2,827
    We do examine pregnant women if they want an exam but we tell them to come back after the baby is born so we can do a re-check. We advise them not to change their eyeglass lenses until after and only buy enough boxes of contacts to get them through their pregnancy. If medicaid wants you to bill with a code for these vision changes perhaps they can supply the codes? It isn't too much to ask. Are there codes for hormonal changes in general?

  7. #7
    Banned
    Join Date
    Jun 2000
    Location
    Only City in the World built over a Volcano
    Occupation
    Dispensing Optician
    Posts
    12,996
    Not only this you want to soak the taxpayers (Medicaid providers) with this? For shame. Give the a box of ABP's and tell them to get over it, see you six weeks after delivery.
    If they have a problem see thier OB, not thier OD.

  8. #8
    Rising Star OptiBoard Silver Supporter
    Join Date
    May 2006
    Location
    il
    Occupation
    Optometrist
    Posts
    1,030
    Jubilee,

    Good for you for providing care that these people need. Don't listen to Chip when deciding on what type of eye care to provide patients or let him feel bad that you are trying to get 20-40% of your normal fee to see these patients IF you can find the right code. Your office should be applauded for seeing medicaid patients.

    Unfortunately, there are dozens and dozens of reasons why the various state medicaid systems are broken; providers charging and getting reimbursed too much is way, way, way down on the list.

    I don't have a good answer for you. If there isn't a direct code, you can usually use a symptoms (ie visual fluctuations). Also might be good to use a 99xxx code instead of a 92xxx in case there is some dude at the medicaid office that thinks 92xxx is only used for "vision exams." In my experience, they'll deny anything for as long as they can and just hope you give up.

  9. #9
    Rising Star OptiBoard Silver Supporter
    Join Date
    May 2006
    Location
    il
    Occupation
    Optometrist
    Posts
    1,030
    Quote Originally Posted by chip anderson View Post
    Not only this you want to soak the taxpayers (Medicaid providers) with this? For shame. Give the a box of ABP's and tell them to get over it, see you six weeks after delivery.
    If they have a problem see thier OB, not thier OD.
    Chip, how many vision problems in child-rearing women are not due to hormonal changes due to pregnancy? How exactly do you tell over the internet? Pregnant women are still allowed to have issues independent of their pregnancy.

    How dare you yell at a fellow poster for accepting 20-40% of their normal fees seeing patients on medicaid. Shame on you.... since we're throwing it around.;)

  10. #10
    Bad address email on file
    Join Date
    Nov 2007
    Location
    kentucky
    Occupation
    Lens Manufacturer
    Posts
    56

    Socialism

    What's next universal healthcare?

  11. #11
    Master OptiBoarder rbaker's Avatar
    Join Date
    May 2000
    Location
    Gold Hill, OR
    Occupation
    Other Optical Manufacturer or Vendor
    Posts
    4,401
    We already have it in The Peoples Republic of Massachusetts. Keep an eye on us.

  12. #12
    Banned
    Join Date
    Jun 2000
    Location
    Only City in the World built over a Volcano
    Occupation
    Dispensing Optician
    Posts
    12,996
    What can one do for "hormonial or other visual fluctuations during pregancy" other than charge a fee? You can't prescribe anything optical as the "fluctuations" will change quicker than the product can be prepared. Kind of like Rx'ing glasses every few days after long term PMMA lens wear.

    Like I said: "If they are having problems with anything during pregancy, they should see an O.B. not an O.D. If there is any goard shaking to be done let the "specialist" diagnose and refer if needed.

    Reminds me of a secretary I once had who had a lawyer for a spouse. He wanted to sue her deceased O.D. for corneal scars from poor contact lens fitting. His reason: "The money is there..." meaning his malpractice insureance would cover damages done while he was alive.

    Reguardless of what many feel "I guess for having suffered through the rigors of thier education." Insurance companies and taxpayers are not a bottomless pit.

    Chip

  13. #13
    Master OptiBoarder
    Join Date
    Sep 2006
    Location
    Kansas
    Occupation
    Dispensing Optician
    Posts
    2,203
    Actually I think you need a diagnosis code, right.
    If they are seen by the Dr for a medical complaint, then you bill the appropriate 99XXX code.

  14. #14
    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
    Join Date
    May 2001
    Location
    United States
    Occupation
    Dispensing Optician
    Posts
    3,197
    What about ladies who may not have needed their glasses, but now do since their vision changed? OR the changes are significant enough that it is causing trouble at work or school?

    What about making sure the patient doesn't have anything besides just a hormonal fluctuation? Believe it or not.. most of the docs round here say if it is eye related, see your eye doctor since they would be most knowledgable in this area. Doesn't matter if you are pregnant, have a history of neuropathy or stroke. Eye= OD, or OMD.

    In order for these people to be able to provide for their children and get off the Medicaid rolls, they need to be able to see and perform their jobs or get their good grades. Changes of 3 steps or more.. can cause a great amount of difficulty.

    I really get tired of this idea that all people we want to do is bilk people for every single penny we can. We don't charge outrageous fees. We don't bill the state for streams of broken/replacement eyewear cause of the warranties we support and pay extra for.. we dont' even charge for visual fields if we recommend one based upon exam findings... We do not discount people or eliminate groups based upon our preconceived notions on what a particular type of insurance means. We simply are trying to do the best job we can at helping our patients see better, while making enough money to keep the doors open and have a modest profit.
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland

  15. #15
    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
    Join Date
    May 2001
    Location
    United States
    Occupation
    Dispensing Optician
    Posts
    3,197
    I will try another round with the 99 codes. The EoB we received stated that we needed a specific pregnancy related code to be paid. Of course, the same group is telling me that they are denying patients due to other possible coverage which isn't even listed on their TPL information. So how are we to know about it?!?

    Cassandra
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland

  16. #16
    Rising Star OptiBoard Silver Supporter
    Join Date
    May 2006
    Location
    il
    Occupation
    Optometrist
    Posts
    1,030
    Why send them to a OB, Chip? If we are only looking at the economics of it, do you seriously think an obstetrician is billing less than an optometrist??? The only thing they will do is to ignore it or tell them to see an eye doctor and then we are into the waste of health resources which you so despise. I doubt an OB has a visual field machine or slit lamp to look at the retina. An ophthalmologist (I'm assuming that is what you mean by specialist) isn't going to look at a visual field, retina, or whatever any "better" than an optometrist. In most of the cases of visual loss, a true specialist would be a neurosurgeon, or endocrinologist. The system isn't set up for a patient to self-refer themselves to a neurosurgeon because they think they may have a tumor. Generally, patients don't run straight to a neurologist because color vision changes or visual acuity loss tell them they may have MS.

    Chip, you need to stop confusing caring for patients (ie making sure they don't have a brain tumor, retinopathy, etc) with selling them spectacles.

    I probably shouldn't be providing you any answers anyway, Jubilee. The state of IL has denied some of my claims three times for the state aid program. I've been open in my office almost 6 months and haven't received a penny from them. It also causes the glasses to be delayed quite a bit as well. Silly, and unnecessary.

    I'm assuming they are wanting a specific ICD-9 code. The 99XXX codes an eye office uses are the same as most other specialties of medicine. I'm guessing this is just one more way for you to provide care without the state actually having to pay for it. But you did already provide the care, so why would the state really care???

    Which is worse? These patients not getting the medical care they need or the doctor's office not getting paid and dropping from the panel? I think there is a good reason why virtually no doctors in my area are providers for medicaid. You'd think with the problems they have the state workers would be bending over backwards to make it easy. We sure as H*ll aren't doing this for the money!

  17. #17
    Rising Star OptiBoard Silver Supporter
    Join Date
    May 2006
    Location
    il
    Occupation
    Optometrist
    Posts
    1,030
    646.90 unspecified complication of pregnancy

    Might be what they need. There are some ICD-9 search websites online and this is all that seemed somewhat appropriate. I've never used it, and if I was to code this for a patient I would probably use something a bit more general like:

    368.1 Subjective visual disturbances
    368.8 Other specified visual disturbances
    368.9 Unspecified visual disturbance

    Any of the 367 codes will be thrown out as "vision" and not covered.

    So, code the 99xxx (whatever level is appropriate for the service provided and the risk, etc.) and use 646.90 as primary, and maybe the 368.1 as the secondary.

Thread Information

Users Browsing this Thread

There are currently 1 users browsing this thread. (0 members and 1 guests)

Similar Threads

  1. Editorial Background: Glare and Vision-Related Quality of Life
    By Newsroom in forum Optical Industry News
    Replies: 0
    Last Post: 06-20-2003, 10:19 AM
  2. Book Review: Diagnosing and Treating Computer-Related Vision Problems
    By Steve Machol in forum OptiBoard News and Announcements
    Replies: 0
    Last Post: 01-14-2003, 07:04 PM
  3. Replies: 3
    Last Post: 01-14-2003, 07:01 PM
  4. Vision-related Quality Of Life
    By Joann Raytar in forum Smart Lens Technology by Transitions Optical
    Replies: 3
    Last Post: 08-21-2002, 09:48 AM
  5. Clinical Research Explores Vision-Related Quality Of Life
    By Newsroom in forum Optical Industry News
    Replies: 0
    Last Post: 08-14-2002, 04:46 PM

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •