coding & reimbursement
"S" Codes: Useful New Options
In certain situations, these codes can do a lot for your practice.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) recently imposed new rules that affect ophthalmic practices. These cover areas such as patient privacy and secure electronic transmission of medical information (including claims). They also include new rules for "standard code sets," which may actually be good news for M.D.s.

Standard code sets for medical practices include ICD-9 coding for diagnoses, CPT coding for most procedures, and HCPCS coding for procedures not covered under CPT. You're probably familiar with HCPCS coding for eyeglasses (V-codes), but other codes also apply to ophthalmology. (See "Ophthalmic HCPCS Codes," at right.)

Q: When should we use these codes? Although Medicare and other federal payers don't recognize the "S" codes, they can be useful for claims to some private insurers. They're helpful when:

• CPT doesn't incorporate a comparable code for a procedure such as corneal topography (S0820)
• the HCPCS "V" codes are insufficient for specialized contact lenses or safety products
• you're invoicing self-pay patients. Patients and staff appreciate an itemized bill far more than an incomplete or ambiguous one, with descriptions like "miscellaneous." For example, the codes for LASIK (S0800), PRK (S0810), and PTK (S0812) help to identify refractive procedures. (This is also helpful for internal tracking.)
• you're coding routine eye exams: healthy patients who come in for a regular check-up and for new glasses or contacts. Most of these exams can be characterized as comprehensive eye exams (CPT codes 92004 for new patients or 92014 for established patients) with refraction (92015) as an added diagnostic test. However, patients who have no medical complaint may balk at paying fees that were set with "sick" patients in mind.

HCPCS codes S0620 (for new patients) and S0621 (for established patients) specifically describe routine eye exams, including refraction. By defining a separate service, they let you set a different fee that may be more acceptable to this group. If you want to build your base of younger, healthy patients, this ability to be price-competitive can be a boon.

Suzanne Corcoran is vice president of Corcoran Consulting Group. You can reach her at (800) 399-6565 or at scorcoran@corcoranccg.com.