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

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).
Contact lens exam services (fitting and evaluation)	Keratometry Slit lamp evaluation (SLE): - 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 Over-refraction performed with diagnostic contact lenses Monocular visual acuity measurements with and without new contact lenses Patient’s subjective and/or doctor’s objective response to the diagnostic lenses 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.
Assessment	Record your clinical impressions and diagnosis.
Plan	The treatment plan is related to the assessment above and includes the following: Ordering information, such as lens material and parameter: base curve, diameter, power, peripheral curves, and thickness, when applicable. Prior to dispensing the contact lenses, verify the lens parameters, if possible. At the time of dispensing the contact lenses, provide instructions for lens care, handling, and wearing schedule. Your patient must demonstrate at this time the ability to handle, insert, and remove the contact lenses. Maintain complete records of financial data relating to contact lens materials, fitting, and management.

Routine Progress Evaluation or Subsequent Visits

Contact lens history	Case history, including lens care and wearing schedule compliance
Contact lens services (evaluation/fitting)	Monocular visual acuities with new contact lenses Over-refraction, if appropriate Slit lamp exam with and without contact lenses Keratometry when indicated Lens movement and centration Note: Anterior segment photos are a separate procedure. We won’t accept them in place of biomicroscopy without separate documentation of anterior segment findings.
Assessment	Record your clinical impressions and diagnosis.
Plan	Recommendations and advice, including the recording of any lens changes or modifications to the lens, wearing schedule, or care Record of any financial transactions

Ordering and Dispensing Contact Lenses

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.
Contact lens	Date contact lens were ordered or indication of stock lenses Brand and type of contacts ordered Unit amounts of contacts ordered Date, brand, type and number units dispensed
Financial records	Patient name Date of service CL brand Type Quantity dispensed U&C cost per box Amount billed to insurance Amount paid by the patient Method of payment

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.

Expired Session

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Contact Lens Case Management Procedures

Procedures and Recording Guidelines