The Big Debate: Medical Versus Vision Eye Coding.

BACKGROUND: Health Insurance Portability and Accountability Act of 1996 (HIP AA)
was enacted to improve the efficiency and effectiveness of the health care system. To
improve efficiency IDP AA required the Human Health Service (HHS) to adopt national
standards for electronic health care. The HHS developed Healthcare Common Procedure Coding System (HCPCS) to aid providers for a more efficient claims processing. HCPCS are divided into two levels. Level I HCPCS are comprised of Current Procedural Terminology (CP'r') codes. CPT* codes are maintained by the American Medical Association (AMA) and are used to bill medical insurance companies. Level II HCPCS codes are used for codes not covered under CPT* codes. PURPOSE: Many vision insurance companies require optometrist to go above and beyond the definition in CP~ codebook for medical eye exams. Vision carriers are also using medical eye codes when the diagnosis is refractive in nature. METHOD: To investigate and determine if vision companies are breaking any laws by rewriting the definition of CP~ codes and by their use of medical eye codes.