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Thread: Prisms and Medicare???

  1. #1
    Master OptiBoarder LENNY's Avatar
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    Prisms and Medicare???

    I had a Post cat medicare patient today (pseudo) with 5 and 6 prisms in his RX.

    I was wondering if we can bill medicare for prisms .
    Do they pay the same for any ammount?
    Does Medicaid pays for them?
    What codes would i use?

  2. #2
    Master OptiBoarder Joann Raytar's Avatar
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    Lenny,

    I found the HCFA website and here is the link to the Medicare Learning Network:This is all they say about coding questions:
    For questions concerning Medicare policy, coding, billing, forms, etc., please contact your Medicare intermediary. Provider toll-free telephone lines have been established at each intermediary to assist Medicare providers with questions and concerns. Contact information for toll-free access to your intermediary can be found at www.hcfa.gov/medlearn/tollfree.htm. If you are not a Medicare provider, but have general questions regarding Medicare, please send your comments/questions to our Customer Service and Feedback resource email box.
    The following is the link to their page with the Provider Toll-Free Customer Service numbers on it:I don't know if this will help. :(

  3. #3
    since 1964 Homer's Avatar
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    Jo ....

    You are a really cool, helpful person. May your tribe increase!

    Homer

  4. #4
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    Yes you can bill Medicare for post op prisms and even slab off prisms if part of the doctors prescription. Also billable is UV if medically necessary.

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    Redhot Jumper

    I'm not sure , but I beleive the code for Medicare would be the same as for Medicaid. The Medicaid prism code is V2715.
    Al

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    Master OptiBoarder LENNY's Avatar
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    Theoretecly if the Rx states to copy the existing PDand that Pd is not what the patien has it means that it adds the prism to the RX.
    Am i correct on that?
    Or i am too smart:bbg: :bbg: :hammer:
    Can we bill for a prism?
    Oh my goooooodddddddddd!

  7. #7
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    Call the doc and tell him what you are seeing and needs to be done maybe he should re-refract or write another RX.

    Just a thought.

  8. #8
    since 1964 Homer's Avatar
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    Lenny ...

    you are correct. So document it and bill for it. You may now need more lines on the form but don't let that bother you.

  9. #9
    Master OptiBoarder LENNY's Avatar
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    I think it may be considered FRAUD!?

    You dont realy have to grind a prism to make a different PD with the patients RX!?

  10. #10
    since 1964 Homer's Avatar
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    Most medicare is multifocals. In multifocals you would have to place the optical center in a certain location. Moving the optical center is grinding prism ...... or another angle for billing fraud ...
    it's your call.

    By the way, did you ever look at the codes for FT-35 bifocals or trifocals?

  11. #11
    Master OptiBoarder LENNY's Avatar
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    No
    I never offered a post cat patient a FT35s!
    I use a billing service that does my Caid and Care billing.
    I dont think he has it on his sheet FT35 or Exec!
    I will talk to him tomorow but most of my post cats are SV NV lenses(if MD did not screw up too much)
    It is hard to get any answers from Medicare themselves but the practice makes it perfect!

    So what do u people think?
    If the rx calls to match PD which is not patients pd Do i bill for A PRISM?

  12. #12
    since 1964 Homer's Avatar
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    Why ....

    Would you give a post IOL patient SV Near?? Wouldn't a bifocal, trifocal or progressive make more sense?

  13. #13
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    You can not bill for grinding prism for decentration. You can bill for prescribed prism with an original copy attached to your records. Slab off prism can be billed for if difference in RX is apparent or script has it indicated on comments line. The same applies for UV as medically necessary.

    Medicare audit requires a copy of the original Rx from the prescribing doctor and as indicated in the doctors medical records. We now use carbon copies of Rx's so the original is retained with the order and the copy given to the patient. They do request these...believe it!

  14. #14
    Master OptiBoarder LENNY's Avatar
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    To Homer

    Most of my IOL patients have no or very small correction for distsance and 70% of them never worn multifocals and even DV pair (they claim they could see perfect on distance) so i am not going to start to put them in to bifocals when their average age is 70!

  15. #15
    since 1964 Homer's Avatar
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    Lenny,

    First, I doubt the 70%.

    Secondly, this is NOT about getting them to try someting they don't want, it IS about convenience, quality of life and presenting all of the options and helping the customer to make an informed choice.

    Funny that probably less than 10% of our post-IOL customers want SV reading lenses except perhapes as a second, special-use, pair.

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