8 Optometry Coding Errors That Could Be Costing You Money

viewing logs of optometry coding errors


  • Optometry coding errors can lead to delayed reimbursements, increased audits, and financial penalties, impacting your practice’s financial health.
  • Maximizing reimbursements through accurate coding is essential for maintaining healthy cash flow in your optometry practice.
  • Awareness of coding mistakes and proactive strategies can improve your practice’s financial performance and workflow efficiency.
  • Modern software tools with autocoding engines and billing services like RevolutionEHR can reduce coding errors and simplify billing and compliance.

If you manage an optometry practice, you know how important it is to maximize reimbursements to maintain a healthy cash flow. Accurate coding is essential to your billing efficiency, ensuring you’re fully compensated for the services provided.

Unfortunately, common optometry coding errors can result in denials, payment delays, and incorrect patient invoices. For instance, misusing modifiers like 25 or 59 can result in compliance headaches and fines, requiring hours to correct and resubmit.

Awareness of these optometry coding mistakes and strategies to avoid them can minimize the risk of costly billing mistakes, improve your practice’s financial performance, and streamline workflows for happier staff and satisfied patients.

The Importance of Accurate CPT Coding in Optometry

Optometrists use Current Procedural Terminology (CPT) codes to describe the types and amounts of services provided to patients. CPT codes are a universal language for all healthcare providers to ensure clarity and consistency in billing.

This standardization is critical for preventing errors and potential fraud. Accurate optometry coding and billing are essential for optometrists. They affect reimbursements and help streamline insurance processes. However, applying the correct code also helps minimize financial and compliance risks like the following:

  • Delayed reimbursements. Incorrect coding can delay insurance payments, affecting your practice’s cash flow and operational budget.
  • Increased audits. Coding errors often trigger audits by insurers, which can be costly and time-consuming to address.
  • Financial penalties. Severe or repeated coding mistakes may result in financial penalties from regulatory bodies or insurance companies. For instance, even a tier 1 fine can be $100 per violation, up to $50,000 total.
  • Loss of credibility. Consistent coding errors can damage your practice’s reputation with patients and insurers, potentially leading to a loss of business.
  • Legal consequences. Non-compliance with coding regulations can lead to legal issues, including fines and sanctions, like exclusions from Medicare or Medicaid, from healthcare oversight organizations.

optometrist viewing optometry coding errors

8 Optometry Coding Errors That Could Be Costing You Money

The first step to smooth billing and compliance is recognizing common optometry coding errors. Here’s a detailed look at the CPT coding errors to be aware of and their potential impact on your practice.

Common Coding Error Definition and Example Impact on Your Practice
1. Over-Coding Billing for a higher level of service than provided. Example: Coding a comprehensive exam when only a basic check was done. Triggers a potential audit and financial penalties due to perceived fraud or misrepresentation.
2. Under-Coding Coding for a lesser service than was provided. Example: Staff makes an optometry billing error by coding for a basic exam instead of a detailed assessment for glaucoma. Can lead to lost revenue and may affect the perceived value of the services provided.
3. Neglecting Billable Procedure Follow-Up Failing to code follow-up visits or procedures that are billable. Example: Staff forgets to code for post-surgical follow-up visits. Results in revenue loss for billable services that were provided but not claimed.
4. Misusing Modifiers Incorrect or unnecessary use of modifiers. Example: Mixing modifier 25 (significant, separately identifiable service) and modifier 59 (distinct procedural service) and applying them inappropriately to claims. Causes claim denials or overpayments that later need to be corrected, impacting cash flow and compliance. The Office of Inspector General (OIG) has seen consistent issues with modifier misuse, making it vital for optometry practices to use them correctly.
5. Incorrect Use of Diagnosis Codes Using outdated or incorrect diagnosis codes. Example: Using an old ICD-10 code for eye infections. Jeopardizes claim processing and compliance; inaccurate coding can delay or negate reimbursement.
6. Not Coding to the Highest Level of Specificity Using vague or general diagnosis codes when more specific codes are applicable. Example: Staff uses H18.9 for corneal disorders instead of specifying the type of disorder. Leads to claim rejections or audits due to non-specific coding, which may be viewed as insufficient documentation of medical necessity.
7. Billing Non-Covered Services without Proper Notification Charging for procedures not covered by insurance without a prior patient agreement. Example: Providing a cosmetic procedure like eyelid surgery without express consent by the patient. Risks patient disputes and potential legal issues; crucial to inform patients about financial responsibilities upfront through the No Surprises Act.
8. Failing to Stay Updated with CPT Code Changes Not updating billing practices to reflect annual CPT code changes. Example: Continuing to use deleted codes, failing to train staff on coding updates, or not using software with updated auto-coding features. Results in claim denials and delays in payment disrupting the financial flow of the practice.

Strategies for Avoiding Coding Errors

So, how do you avoid optometry coding errors? You can prevent coding issues at your practice with proactive strategies. The following practices can improve your coding accuracy and compliance.

  • Regular training sessions. Schedule periodic training to keep staff up to date on the latest coding rules and changes. Subscribe to the American Academy of Professional Coders (AAPC) or Centers for Medicare & Medicaid Services (CMS) for essential coding guidelines and updates, and hold meetings to discuss key points.
  • Coding audits. Implement a routine schedule for auditing your coding practices. Use manual checks or engage external auditors to systematically review and verify the accuracy of the codes being used.
  • Continuous education. Ensure staff regularly participate in workshops, seminars, or webinars on coding topics to stay informed on evolving coding standards and insurance regulations.
  • Modern software tools. Invest in the latest billing and practice management software to automate and simplify the coding process. Use a system with an advanced autocoding engine for quicker, more accurate billing and insurance.

viewing optometry coding errors on a tablet

RevolutionEHR and RevBilling

RevolutionEHR is an all-in-one practice management, billing, and EHR system that helps optometrists avoid common coding errors. Combined with add-on, integrated services like RevBilling, your practice can see tangible benefits from:

  • Seamless claim submissions. RevolutionEHR sends claims to payers, simplifying the submission process and minimizing errors from manual entry.
  • Quick claim-rejection handling. You can quickly address and correct rejected claims within RevolutionEHR, streamlining the resubmission process and accelerating payment receipt.
  • Efficient patient statement processing. Integrated with RevolutionEHR, RevClear automates patient statements, improving efficiency and reducing the administrative load by about 8.5 minutes per claim translation.
  • Boosted revenue recovery. Integrated with RevolutionEHR, RevClear improves the recapture of denied claims by around 60%, improving revenue recovery efforts and helping you achieve a 98.06% payer acceptance rate.
  • Faster payments. RevolutionEHR and RevBilling help reduce the transaction time per claim and cut costs associated with processing statements, resulting in faster payments.
  • Expert revenue cycle management. RevBilling offers a dedicated team of revenue cycle experts who focus on optimizing your practice’s financial health and ensuring you receive the payments you deserve.
  • Accurate claims submission. RevBilling maximizes practice revenue by ensuring accurate claim submissions, leading to quicker reimbursements.
  • Data-driven financial insights. RevBilling allows for data-driven decision-making with analytics that drive best practices in financial performance.
  • Secure, cloud-based access. RevolutionEHR’s cloud platform ensures secure data access from anywhere, supporting compliance and reducing risks associated with data breaches.
  • Customizable and scalable solutions. Tailor RevolutionEHR to meet your optometry practice’s specific billing and coding needs, helping you scale your business at your own pace.

Eliminate Costly Optometry Coding Errors With REvolutionEHR

Optometry coding errors can cost your practice hundreds or even thousands of dollars in missed revenue or fines. When you switch to RevolutionEHR’s integrated practice management and billing system, you can avoid CPT code mistakes and optimize your billing to boost revenue.

RevolutionEHR allows you to focus on patient services or practice growth through automatic coding that minimizes errors and administrative work. Schedule a demo today to see it in action.

a new vision for your optometry practice