How to bill DMERC for a progressive

[MarcE]

Ladies and Gentlemen,

I have a very specific question regarding billing a progressive following cataract surgery.

As many of us know, a progressive lens is billed on two lines. A "bifocal (V22XX) or trifocal (V23XX)" on the first line with a "Progressive (V2781)" on the next line showing that this is a patient preference. I put this in quotes because all the DMERC carriers and coding tips and training all say exactly the same thing.

The question is: Which code do you use on the first line? BF or TF. It makes a difference in the patients obligation. Not much difference in our total revenue collected (just a bit though).

I just want to be right. My thinking is if it's over a +2.00 add, use a V2300. <= to +1.75, use a BF.

What do you guys know to be true?

Thanks for all your help!

Marc

[obxeyeguy]

We use tri (V23XX). Not really sure why that would effect your total revenue though...

[PAkev]

DMERC only pays up to their UCR maximum fee which is different for specific regions.
2200 will enable you to collect more $ up front for the difference between FT and PAL.
2300 will diminish the additional cost to the patient as the UCR fee is slightly higher.

Therefore, if you want more $ when the patient is serviced use 2200. If you want to make PAL lenses more affordable to your patients and can wait until you recieve $$ back from DMERC than use 2300.

I personally always used 2200 because there are always a few claims that get denied or held up. Trying to catch up with patients to pay for something they believe their insurance should pay is worse than pulling teeth. So my strategy is to reduce this risk and minimize our Accounts Receivable.

[cmarx]

We always bill trifocal no matter what the add is.

[shertling]

We always bill a bifocal no matter what the add is.

[Geirskogul]

For 20 years we have billed as a trifocal with the prog addon

[PAkev]

I really think it all depends on if they are getting
"No-Line" bifocals or "No-Line" Trifocals:bbg:

[Java99]

For 20 years we have billed as a trifocal with the prog addon

Same here.

[bwoz]

I know this is a pain, but I look into the guidelines from the Medicare Carrier for the region. Most of the process is the same for everyone, but depending on your LCD, your Carrier may like to see codes split up in a different way than others.