Common Billing and Coding Blunders

Learn from these prevalent mistakes to thrive financially today and in the future.

By: Tonya M. Reynoldson, OD, MBA

Optometric Management January 2, 2026 Vol 61, Issue January-February 2026 Page(s): 12-14

5 Key Takeaways

1

The coding landscape for optometrists is increasingly complex due to evolving CMS policies and heightened payer scrutiny.
2

Many optometrists continue to use outdated 1997 documentation rules, leading to common coding mistakes and potential legal issues.
3

Medical decision making is now the primary driver for code selection, yet many practitioners underestimate its importance.
4

Improper modifier use, particularly with -25 and -59, is a frequent error that can trigger audits and lead to improper payments.
5

Documentation of medical necessity and adherence to payer-specific guidelines are crucial to avoid billing errors and ensure compliance.

Tonya M. Reynoldson

Specialties: Optometric billing and coding

Bio: Tonya M. Reynoldson, OD, MBA, is an optometrist who writes about billing and coding for Optometric Management. Her article in the January-February 2026 issue focuses on common billing and coding errors in optometric practice, including revised evaluation and management guidelines, medical decision making, payer scrutiny, and documentation pitfalls.

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Optometric Management

Common Billing and Coding Blunders

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