March 2022.  For several months, VSP has been experiencing a glitch with the way they process dual benefit coordinations for glasses. Even when opticians files the COB correctly, VSP has been processing the coordination wrong. On the VSP remit, the patient will have two back-to-back claim entries, but both process as primary, costing the practice money. As OBS billers come across these errors, we are calling VSP and asking them to correct it.

As many optometrists are aware, the CDC and AOA have both recommended all routine eye exams be rescheduled because of the coronavirus outbreak.  Medicare has also issued three new coding options to help address the challenges COVID-19 is presenting to optometrists.

First, optometrists are now allowed a VIRTUAL CHECK-IN with patients for follow-up visits.  If the physician has not seen the patient within the last seven days and will not see the patient again for 24 hours, they can use this option.  Virtual check-ins are 5-10 minute visits over the phone or using captured video or images that are billed with G codes.  Physicians can’t bill this option if they decide to have the patient come in within 24 hours.  G2012 is used for telephone follow-up visits and G2010 is for captured video or images. The reimbursements for these G codes are generally low, around $15.

The second option, called ON-LINE DIGITAL EVALUATION, is communication with patients through the physician’s online portal. If the patient initiates the portal contact, the physician can bill for the cumulative time they spend communicating with the patient over a seven day period, provided they don’t see the patient for a medical visit within 24 hours. Previous HIPAA requirements or the capabilities to store these patient communications have been waived during the COVID-19 emergency. The billing codes are based upon total time spent answering the patient through the portal: 99421 is for 5-10 minutes and reimburses around $15.52; 99422 for 11-20 minutes, $31.04; and 99423 for 21 or more minutes, $50.16.

Finally, Medicare’s new COVID-19 guidelines allow for TELEHEALTH SERVICES. These are office visits conducted over video applications such as Facetime or Skype and are billed with the 99-series evaluation and management codes, such as 99212 or 99213.  The 92-series eye exam codes do not apply.  Unlike previous telehealth guidelines, this option is no longer restricted to remote or rural areas, the patient can be at home, and providers do not have to use a HIPAA compliant software, only any real-time audio and video for live, interactive telecommunication between the provider and patient.  Billing for telehealth exams requires some software setup for required modifiers and place of service, so if any of OBS doctors decide to utilize this option, please notify your coordinator or Branda so that we can ensure the claims have the proper coding.

So far these three billing options have only been approved by Medicare, but because Medicare sets the gold standard in billing, other commercial payers often follow. Some commercial carriers may already have other remote billing options in place for telephone evaluations. We can only advise providers to check with their local commercial insurance carriers to see what options they may have to continue to provide medical eye care to patients throughout this emergency.

Here are links to the AOA webinar held on March 17 that covers Medicare’s changes in more detail:   AOA Recorded Webinar     Link to PowerPoint