Explanation about billing charges for your Yearly Comprehensive exam

Yearly comprehensive exam

This type of visit is defined by insurance companies as a yearly check up to assess your visual system and Eye health. Unlike a simple vision screening which only assesses your vision a comprehensive exam includes a battery of test in order to do a complete evaluation of the health of your eyes and your vision.   This type of appointment will address preventative screening care along with a diagnosis like nearsightedness farsightedness astigmatism or presbyopia.

Problem Oriented Visit 

This type of visit includes the diagnosis, management and treatment of temporary or ongoing problems such as dry eye, corneal abrasions, cataracts, diabetic retinopathy, infections or injuries.

These two types of services are distinct. Your medical and vision insurance companies treat them as distinct appointment types even if they occur during the same visit.  Providers are required to code type of service separately even if performed during one visit.  Because of this requirement, an additional charge may occur if there is discussion or management of a problem at the time of a routine eye exam appointment. Because of contractual agreements with insurance companies and Medicare, there is a legal obligation to code correctly for problem visits.

To avoid misunderstanding, yearly comprehensive exam visits are scheduled as yearly exams usually covered once a year by your vision insurance such as VSP or MESC.  Please schedule problem visits when they occur. Frequently problem discussions arise during yearly comprehensive exam visits . If time allows, they can be addressed. In this circumstance, an additional visit code will be applied to the visit.

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