Contact Lens Case Management Procedures
Contact lens services (evaluation/fitting) are in addition to eye exams.
Diagnostic contact lens fittings can be for a first-time contact lens wearer or a refit patient. The diagnostic fitting includes your patient’s contact lens history, evaluation/fitting services, assessment, and a treatment plan. We define a contact lens refit for those patients who have worn contact lenses before but must fit into a different parameter (base curve, diameter, etc.) or different lens type (RGP to soft, spherical to toric, extended wear to daily wear, etc.).
If your patient’s case is complex and you choose to refer them to another doctor, we’ll reimburse you for the eye exam level of service provided. If the referral is to a doctor outside your practice and you’ve already billed us for a comprehensive level of service, we’ll pay that doctor an intermediate exam service fee plus contact lens fees for services and materials. If you provide both services, we’ll pay the global fees.
Procedures and Recording Guidelines
We require evaluation and record-keeping as outlined in each area below. Per HIPAA Rules, medical records must be retained and accessible for six years (ten years for Medicare managed care program providers) or as required by federal/state law, from the date of its creation or the date when it last was in effect, whichever is greater.
Note:
The medical record should be complete and legible, and each encounter should include the date of service and legible identity of the provider performing the service and their signature or electronic identifier. The patient’s medical record is considered incomplete without the doctor’s authentication that the information is a true and accurate representation of the service provided.
Diagnostic Contact Lens Fitting
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Contact lens history |
Additional case history impacting the use and care of contact lenses (e.g., work conditions, desired wearing schedule, previous lenses, and solutions). |
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Contact lens exam services (fitting and evaluation) |
- With diagnostic contact lenses to assess lens fit (record the diagnostic lenses through which all tests are performed) - Without contact lenses to assess condition of the cornea,sclera, conjunctiva, lids, or tear film
**Note: Anterior segment photos are a separate procedure. We won’t accept them in place of biomicroscopy without separate documentation of anterior segment findings. **Note: Use of diagnostic tools such as ocular wavefront aberrometer, autorefractometer, corneal topographer and keratometer does not replace the requirement to record clinical findings in the patient’s records. |
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Assessment |
Record your clinical impressions and diagnosis. |
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Plan |
The treatment plan is related to the assessment above and includes the following:
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Routine Progress Evaluation or Subsequent Visits
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Contact lens history |
Case history, including lens care and wearing schedule compliance |
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Contact lens services (evaluation/fitting) |
**Note: Anterior segment photos are a separate procedure. We won’t accept them in place of biomicroscopy without separate documentation of anterior segment findings. |
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Assessment |
Record your clinical impressions and diagnosis. |
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Plan |
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Ordering and Dispensing Contact Lenses
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Manufacturer contact lens order |
Contact lens order details to/from the manufacture to include type of contact lens ordered, unit amounts, patient for which the contacts are for and the order date. |
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Contact lens |
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Financial records |
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When billing VSP for contact lenses, you must keep a list of your contact lens material U&C fees and costs for services/materials (e.g. Fitting/Evaluation(s)) for reference. This must be shown to any VSP Representative upon request.