q & a
HIPAA contains a silver lining.
By Suzanne Corcoran, C.O.E.
The Health Insurance Privacy and Accountability Act of 1996
(HIPAA) has just imposed new patient privacy rules on optometric practices. Also, new security rules will soon govern electronic transmission of medical information, including claims. But the law may actually contain some good news for doctors -- it's third part, which sets rules for "standard code sets."
The standard code sets for medical practices include ICD-9 coding for diagnoses, CPT coding for most procedures and HCPCS coding for other procedures and for eyeglasses (V-codes). Other codes out there do apply to optometry (see "Optometric 'S' Codes" at right).
When should we use them?
The "S" codes are useful for claims to some private insurers; Medicare and other federal payers don't recognize them. They're helpful when CPT doesn't incorporate a comparable code such as corneal topography (S0820) or when the HCPCS "V" codes are insufficient to cope with specialized contact lenses or safety products.
Finally, these codes may be useful for invoicing self-pay patients or for internal tracking purposes. Patients and staff appreciate an itemized bill far more than an incomplete statement or one with ambiguous descriptions such as "miscellaneous." For example, the codes for LASIK (S0800), PRK (S0810) and PTK (S0812) may help identify refractive procedures.
Codes to the rescue
Ophthalmologists and optometrists have long struggled with proper coding for routine eye examinations. You know the type -- healthy patients who come in for a regular check up and for new glasses or contacts. We can characterize most of these examinations as comprehensive
(CPT codes 92004 for new patients or 92014 for established patients) with refraction (92015) as an added diagnostic test. But what about pricing? These patients don't have any medical complaint and may balk at paying your usual fees, especially when you set those with "sick" patients in mind.
This is where the HCPCS codes S0620 (for new patients) and S0621 (for established patients) come in handy. They specifically describe routine eye examinations, including refraction. By defining a separate service distinct from your usual eye exam, they also permit a different charge. Another fee may be more acceptable to this group of patients. For practices that want to build their base of younger, healthy patients, the ability to be price-competitive can be a boon.
SUZANNE CORCORAN IS VICE PRESIDENT OF CORCORAN CONSULTING GROUP. REACH HER AT (800) 399-6565 OR AT
Optometric "S" Codes
Disposable lens, per lens
S0504 Single-vision prescription lens
(safety, athletic or sunglass), per lens
Bifocal prescription lens (safety, athletic or sunglass), per lens
Trifocal prescription lens (safety, athletic or sunglass), per lens
Nonprescription lens (safety, athletic or sunglass), per lens
Daily wear specialty lens, per lens
Color contact lens, per lens
S0516 Safety eyeglass frames
S0580 Polycarbonate lens (add this
code to the basic code for the lens)
Nonstandard lens (add this code to the basic code for the lens)
Integral lens service
S0592 Comp. contact lens evaluation
Routine ophthalmological exam including refraction; new patient
Routine ophthalmological exam incl. refraction; established patient
S0820 Computerized corneal topography, unilateral
Optometric Management, Issue: April 2003