refractive error or routine vision diagnosis?

[bwoz]

I'm just curious as to how others code their exams. If a patient presents with no complaints and you find a refractive error, do you code the claim with the actual refractive error as the dx or do you use V72.0 routine va? I know this may vary depending on payors' guidelines, but I was just wondering in general. Thanks!

[cocoisland58]

If there is a refractive error found I use the diagnosis code for whatever that might be.

[harry888]

Diagnosis codes ending in zero usually have trouble, "not specific enough".

For me, most insurers will pay for myopia, 367.1, but not for Hyperopia, 367.0

Harry

[bwoz]

Diagnosis codes ending in zero usually have trouble, "not specific enough".

For me, most insurers will pay for myopia, 367.1, but not for Hyperopia, 367.0

Harry

Dr, you're using 367.0 correctly because it only requires a fourth digit so you are being specific enough. I have no idea how that payor can be justifying that denial. Nearsightedness vs. farsightedness??? That's crazy, MassHealth even processes that one. My clients are in MA and I don't have any issues with that dx off the top of my head, maybe it's one of those payors that want you to use V72.0 as primary in these cases? I'd call my provider rep (and hold my breath!)

Thank you to both of you for your input.

[bwoz]

So does anyone ever use V72.0 primary?

[drk]

I use V72.0 as the diagnosis when there are no abnormal findings on the routine exam.

I use the 367's for refractive diagnoses when present, and for the sake of parsimony do not add V72.0.

Of course you're right: if a carrier wants V72.0 "examination of eyes and vision, routine", then you do it. I can see how a medical or government payor would like that for classification's sake.

FWIW, as many here are aware, VSP's Eyefinity claim portal will by default populate the CMS-1500 diagnosis box #1 with "V72.0" and they request that you add additional diagnoses. Maybe they want a diagnosis on their records, as well, even though payment is not contingent upon diagnosis.

[MarcE]

FWIW, as many here are aware, VSP's Eyefinity claim portal will by default populate the CMS-1500 diagnosis box #1 with "V72.0" and they request that you add additional diagnoses. Maybe they want a diagnosis on their records, as well, even though payment is not contingent upon diagnosis.

Most payors (including the Gov't) could take a lesson from VSP. It's consistent, it's straightforward and the system won't let you submit a claim that will be rejected later. You may not like what they pay, but you always know where you stand. And if they say they will pay - they DO pay. And within 2 weeks.

VSP took over part of our state Medicaid billing. They now cover poly on all kids, they cover TD2 on some kids, they have a higher frame coverage and actually higher exam coverage. We get paid in 2 weeks instead of 3 months, and you can get authorized without talking on the phone. 100% better. I wish VSP would take over DMERC billing.

[bwoz]

Most payors (including the Gov't) could take a lesson from VSP. It's consistent, it's straightforward and the system won't let you submit a claim that will be rejected later. You may not like what they pay, but you always know where you stand. And if they say they will pay - they DO pay. And within 2 weeks.

VSP took over part of our state Medicaid billing. They now cover poly on all kids, they cover TD2 on some kids, they have a higher frame coverage and actually higher exam coverage. We get paid in 2 weeks instead of 3 months, and you can get authorized without talking on the phone. 100% better. I wish VSP would take over DMERC billing.

I wish they would take over for the state of MA. MassHealth is JUST NOW implementing the CMS-1500 forms like the rest of creation. Exams, glasses, and c/l's have to be filed under their own claim form which of course does not line up on print as the CMS claim forms. So our providers have to be filing electronically or HAND WRITE/type the forms out!!!!!! Not very cost effective for anyone IMHO.

I agree about VSP, at least they do what they say they will do and the v72.0 is defaulted on the website when you enter a claim.

DrK you basically summed up what we follow too.

Thanks for the input

[Dannyboy]

I thought VSP required electronic claims for higher reimbursement.