Ophthalmology Billing Services

Cataract and retina surgery, global periods, diagnostic imaging, and the medical-versus-vision routing.

Ophthalmology practices lose money when a visit is routed to the wrong plan. The reason for the visit decides whether it is a medical claim or a vision plan claim. What you find during the exam does not change that. Our ophthalmology billing services route at check-in, not at checkout.

Groups comparing ophthalmology medical billing services should also ask about surgical global periods and co-management. Cataract surgery carries a global period that is often shared with an optometrist. The transfer of care modifiers have to be on both claims, or one of them denies.

Our Services

Eye Codes and E/M Codes

Ophthalmology has several subspecialties, so claims draw on a wide set of codes. Two groups matter most: eye codes and E/M codes. Filing both correctly is harder than it looks, and a lot of ophthalmology billing companies end up with a large accounts receivable because of it.

We keep AR low. You are trusting us with your practice revenue, so we put people on it who understand the detail of ophthalmology medical billing services and work carefully.

What benefits are provided by our Ophthalmology Therapy Billing and Coding Services?

  • Thoroughly-Thought Billing (TTB)

    We check a claim before we file it, and we also check that it can actually be collected. That helps both sides. Your accounts receivable stays low, ours does too, and the money comes in steadily.

    No OON Billing

  • No OON Billing

    Out-of-network billing is something many ophthalmology billing companies ignore. That creates more work, longer days and unhappy patients when the claims are denied. We handle it differently. If we are not contracted with the payer, we say so up front and save everyone the time.

    Procedure icon

Procedure

Our comprehensive Ophthalmology billing services cover every specialty, supported by the expertise of a specialized coder and, equally importantly, a skilled biller:

  • Cataract Surgery
  • Retina Surgeries
  • LASIK (laser in-situ keratomileusis)
  • Glaucoma Surgeries
  • Corneal Transplant
  • Eye Muscle Surgery
  • Blepharoplasty

Eye codes, E/M codes and the tests in between

Ophthalmology has its own code family alongside the standard office visit codes, and choosing between them is a payment decision practices make by habit.

Which code set to use

The general ophthalmological service codes describe an eye examination. They come in new and established versions, at two levels each. The office visit codes describe a medical evaluation. Either can be correct. The eye codes often pay better for a full examination. The office visit codes fit better when a medical problem drives the visit and the thinking is the work.

What does not work is defaulting to one set for every patient. The record has to support whichever was billed, and for the eye codes that means the examination elements and the initiation or continuation of a treatment programme are actually in the note.

Testing has frequency limits

Visual fields, optical coherence tomography and fundus photography are all covered. All three have policies that limit how often they are payable for a given diagnosis. Two rules cause most denials. Some test pairs are not payable on the same day for the same eye. And repeating a test more often than the policy allows is denied even when it was clinically reasonable, unless the record explains the change that prompted it.

Check the local coverage policy for your carrier before setting a recall interval, because the interval is what generates the denials.

Cataract surgery and the global period

Cataract surgery carries a ninety day global period, and the payment covers the routine after care. Two things get missed. The eye has to be identified with the correct side modifier on every claim, and the second eye is a separate procedure with its own global period, not a continuation of the first.

Where the surgeon operates and an optometrist gives the after care, the work is split between them. The transfer of care has to be written down, and both claims need the right modifier. Doing that informally, without the documentation, is the version that gets recouped.

Ophthalmology Credentialing: ASC Privileges and Vision Plans

Ophthalmology credentialing runs on two payer systems at once. Medical plans cover disease of the eye. Vision plans such as VSP and EyeMed cover refraction and eyewear, and they credential you separately, on their own forms. A practice that only enrols with the medical side turns away routine patients without realising why.

Surgery adds the second layer. Cataract and retina work needs hospital or ASC privileges, and those are granted by each facility on its own timetable. If you run in-office imaging or a minor procedure room, check the supervision and enrollment rules before you bill the technical component.

We handle medical enrollment, vision plan credentialing and facility privileges together. See our medical credentialing services.