Editor's Perspective

To Bill or Not to Bill

editor's perspective
To Bill or Not to Bill

Our 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.

I 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 two?

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 option.

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.