Medical Coding Essential to Comprehensive Care

O.D. finds quality, thoroughness of care increases

Richard Solomon, O.D., who holds two LensCrafters leases in the Maryland suburbs near Washington, D.C., began delving into medical coding and billing in January 2007. "I had always wanted to create a more comprehensive practice overall. That means being the patients’ primary care provider and referring only those patients who needed subspecialty care," he says.

The benefits of embracing the medical model of optometry, he thought, would be a more loyal patient base. "The more often you see a patient, the more likely he or she is to take advantage of your refractive vision services," he says. Indeed, that’s just what has happened. "When patients come in for ocular allergies or infections, they often buy additional contact lenses," he says.

As a result, his revenues and patient base have increased with no downturn in the core refractive eye care services, he says. "Every patient who comes in the door represents potential referrals. The practice is listed as a participating provider, so it follows that patients who come to us for a medical condition add significantly to our referral base."

Dr. Solomon, his six associates and his staff members all make a point of telling patients the variety of refractive and medical services they provide. The staff also makes sure that they collect the patients’ medical and vision insurance information and that all patients understand that medical and vision insurance are separate policies. "We educate every single patient, every single day, that vision insurance is for the eye exam and glasses or contact lenses and that the medical insurance may cover allergies, irritations and eye emergencies."

It’s critically important for Dr. Solomon to know what medical and vision insurance the patient has before starting the exam, he says. For routine vision exam patients with a medical plan, Dr. Solomon explains that as a participating provider, he can work with them on any medical eye care need in the future. Most patients don’t know that, he says. But as a result of his explanations to all patients, "I am seeing our existing patients for more visits. We remain their source for refractive needs, but now we are also their source for complaints due to allergy, dry eye or infections."

To ensure proper billing, Dr. Solomon emphasizes that it must be the O.D. who records the patient’s chief complaint. Insurers require that the chief complaint match the billing codes. Having patients or staff answer that question could lead to rejection of the bill. To keep that from happening in his office, "the chief complaint is only on the exam form, not the comprehensive history form, so it’s only available to the doctor. That way, the chief complaint, review, exam history, assessment and plan will all be consistent," Dr. Solomon says.