VSP Diagnostic Codes and Questions...

**Uncle Fester** · 10-01-2015, 01:58 PM

This is an attempt to keep the the questions in one thread.

If what I'm hearing is right VSP will now require ICD-10 codes not only in the diagnostic column but procedure as well.

About 25 pages worth.

We thought the optical end was going to dodge this bullet but I'm told we can't. So far it's VSP but can Eye Med be far behind?

Please tell me if I'm wrong!!!

**Jubilee** · 10-01-2015, 02:08 PM

ICD 10 affects only the diagnostic codes. The procedure codes did not change. So Myopia will be H52.1_ (1,2, or 3 depending on Rt, LT or OU) and you would still bill the V210X depending upon the power of the lenses.

**Uncle Fester** · 10-01-2015, 02:13 PM

Just did a private pay job and whereas before I could just write in V72.0 and arrow down. My program is now requiring a Z01.00 entry for each line. To get it to appear requires several clicks. Ugh.

**David_Garza** · 10-01-2015, 02:19 PM

Originally Posted by Uncle Fester

Just did a private pay job and whereas before I could just write in V72.0 my program is now requiring a Z01.00 entry for each line. To get it to appear requires several clicks. Ugh.

Sue VSP for carpal tunnel syndrome <insert new ICD10 code here>

**newguyaroundhere** · 10-01-2015, 03:49 PM

Originally Posted by David_Garza

Sue VSP for carpal tunnel syndrome <insert new ICD10 code here>

S30.867A.....I think......

**Dr. Bill Stacy** · 10-01-2015, 04:10 PM

Originally Posted by Jubilee

ICD 10 affects only the diagnostic codes. The procedure codes did not change. So Myopia will be H52.1_ (1,2, or 3 depending on Rt, LT or OU) and you would still bill the V210X depending upon the power of the lenses.

Indirectly, I think it's changed. You might need to link the procedure code line(s) to the appropriate diagnostic code(s), now by letters instead of integers. And there may be different icds for R and L.

iD · 10-01-2015, 06:47 PM

the basic ones are
Z01.00 normal exam

H52.03 for Hypermetropia (Both Eyes)
H52.14 for Myopia (Both Eyes)
H52.223 for Regular Astigmatism (Both Eyes)
H52.4 for Presbyopia

**Uncle Fester** · 10-02-2015, 10:42 AM

You now must enter a diagnosis code in box 21 even for materials only.

I used Z01.00

Don't know about you but our office is in the habit of entering charges then "saving". We open reports and then go to the savings statement to be sure our total equals what they say we should charge before submitting.

Per VSP a "glitch" occurred in this order. Patient amount $18.40 less than what should have charged. This happened occasionally under Choice but this was a Signature plan. Lets hope it's not a trend!

iD · 10-09-2015, 07:16 PM

Originally Posted by Uncle Fester

You now must enter a diagnosis code in box 21 even for materials only.

I used Z01.00

Don't know about you but our office is in the habit of entering charges then "saving". We open reports and then go to the savings statement to be sure our total equals what they say we should charge before submitting.

Per VSP a "glitch" occurred in this order. Patient amount $18.40 less than what should have charged. This happened occasionally under Choice but this was a Signature plan. Lets hope it's not a trend!

thanks for the box 21 info. Is there anything else that requires to be filled out due to ICD 10?

**Uncle Fester** · 10-20-2015, 10:30 AM

Am I missing something or to process a VSP without an exam (materials only) you still must enter a code?

I'm just guessing and putting in a Z01.00. Is there another I should use or way around it?

**HarryChiling** · 10-20-2015, 11:23 AM

Originally Posted by Uncle Fester

Am I missing something or to process a VSP without an exam (materials only) you still must enter a code?

I'm just guessing and putting in a Z01.00. Is there another I should use or way around it?

The Z01.00 is a generic code that describes an exam with normal findings. It is better to use the H52 that iD had in a post above for the frame and lenses. Otherwise the procedure reads as normal findings in exam sold them progressive lenses. If you had used H52.4 then the story reads patient has presbyopia, sold them a progressive lens. It might not be an issue now but later on an incomplete story is going to elicit a response from some carriers that results in a denial. Start good habits now.

**Uncle Fester** · 10-20-2015, 01:34 PM

Thanks for clearing that up Harry- I thought it was wrong!

**HarryChiling** · 10-20-2015, 02:01 PM

Right now implementation is the focus but I can see a day where the diagnosis codes on an exam could be used to reduce material payments. For example a balance lens maybe reimbursed at a reduced rate in the future with icd 10 the coding could be used to automate the reduction on the back end with a simple check. I haven't heard anything like that so far but icd 10 gives the insurance companies a more detailed diagnosis which may allow an automated protocol to be informed when it comes to material coverage.

**Uncle Fester** · 12-15-2015, 02:47 PM

VSP Choice "Computer Vision" benefit- What code do I use for box 21 A? My Z01.00 is being rejected. I rarely use this plan.

OOpps! Let me enter Harry's H52 suggestion first!!!

Rats- That's not valid either. Anyone???

**EyeCare Rich** · 12-15-2015, 02:53 PM

I believe you should be fine with Presbyopia H52.4. Not sure what you are refering to as "Computer Vision". What was the Doctors Diagnosis?

**Uncle Fester** · 12-15-2015, 02:59 PM

Originally Posted by EyeCare Rich

I believe you should be fine with Presbyopia H52.4. Not sure what you are refering to as "Computer Vision". What was the Doctors Diagnosis?

Thanks- I'll give it a try right now. It's a second pair computer benefit. The exam is on another authorization and has gone through fine with Z01.00.

H52.4 did the trick- Thanks Eye Care Rich!!!*

*(I'm such a poet!)