The vision vs. medical conundrum – Ophthalmology Management

Patients, as well as staff, are often confused about whether an exam qualifies as a vision exam or a medical exam. Here are answers to some common questions.

This article answers the following questions:

  • If a patient has both medical and vision insurance, which is primary?
  • Does Medicare cover “routine” and “annual” exams?
  • When a patient comes for a routine vision exam and we find pathology, may we bill the medical plan?
  • Is it ever possible to bill both medical and vision insurance?
  • What happened to the local codes that used to describe routine eye exams?
  • How can we reduce confusion with patients on this subject?
  • How should we respond if a patient asks us to modify a claim to avoid personal financial responsibility?

This article was published in Ophthalmology Management’s Coding & Reimbursement column, which is written by Corcoran’s Executive Vice-President, Suzanne Corcoran, COE. To view the entire article in Ophthalmology Management, click on the link below:

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