Bill or Not to Bill
JOSEPH T. BARR, OD, MS, FAAO, EDITOR
recent discussions about contact lens profitability emphasized the topic of treating
and being reimbursed for contact lens complications. Of course we'd rather just
talk about the good news: Better and more comfortable lenses, specialty lens success
and better lens care products. But let's face it, sometimes the eye doesn't cooperate,
and certainly many patients aren't compliant with their new great products.
think patients whom we treat for contact lens complications fall into three categories.
First are new patients whom we've recently fit with contact lenses and who are currently
in the follow-up monitoring process. Their complications can range from toxicity
reactions to infiltrative keratitis to conjunctivitis to allergic conjunctivitis.
I've asked many contact lens practice management experts how comfortable they feel
charging beyond their fitting and follow-up fee to treat complications for recently
fit patients, and most are reluctant to bill for them. Nevertheless, you may have
good reason to bill these patients, such as if they're clearly being noncompliant
with their wear schedule for example, when a patient develops an acute infiltrative
keratitis from overnight wear after you obviously prescribed a daily wear schedule.
Of course the tough decision, and one that we should probably spell out, is how
long does the care for a compliant patient last after initial fitting and follow
up? A few months? Until you've provided a prescription after only a check up or
The second category include patients who've developed a complication
after you released them with a prescription following the fitting and post-fitting
monitoring period. These patients should fully expect you to charge them for treating
their contact lens-related complication and yet you probably wish more would
remember that you informed them to expect this. Make sure you bill the maximum that
you can justify medically, and no more. Our sister publications Optometric Management
and Ophthalmology Management provide good information about how to do this,
and we've published articles in the past on billing for contact lens care.
Finally, patients who've been fit elsewhere and who now have complications
such as giant papillary conjunctivitis or infiltrative keratitis will need your
care. It's easiest to make the decision to bill these patients, and they seem to
understand that they need to pay for your services and then be refit with a better
We all need to think about our policies and procedures for cases
of contact lens complications and to learn how to properly code these events so
that our reimbursement is as good and as legal as it can be.
Contact Lens Spectrum, Issue: April 2006