Optometry Billing and Coding Course

Lesson 1 • Optometry Practice Types and Settings

Distinguishes solo, group, and retail optometry settings and their billing implications. Connects practice structure to claim submission requirements.

Lesson 2 • Insurance Plan Structures

Explains vision, medical, and managed care plan structures relevant to optometry. Students distinguish plan types to determine correct claim routing.

Lesson 3 • Introduction to Claim Forms

Familiarizes students with standard professional and institutional claim forms used in optometry. Provides a map of each form's fields before detailed coding begins.

Lesson 4 • Regulatory and Compliance Overview

Covers patient privacy rules, anti-fraud statutes, and payer compliance requirements. Grounds students in the legal obligations that shape every billing decision.

Lesson 1 • Diagnosis Coding System Structure

Explains the alphanumeric hierarchy, chapters, and conventions of the current diagnosis coding system. Provides the structural foundation needed before assigning any eye care code.

Lesson 2 • Coding Guidelines and Conventions

Applies official coding guidelines including laterality, acute vs. chronic conditions, and combination codes. Prevents common errors that trigger claim denials.

Lesson 3 • Systemic Conditions Affecting Vision

Teaches coding for diabetic eye disease, hypertensive retinopathy, and autoimmune ocular manifestations. Demonstrates how systemic codes interact with ocular codes on claims.

Lesson 4 • Refractive and Low Vision Coding

Addresses codes for refractive errors, amblyopia, strabismus, and low vision. Connects accurate diagnosis coding to appropriate service and supply reimbursement.

Lesson 1 • Contact Lens Services Coding

Addresses fitting, evaluation, and supply codes for soft, rigid, and specialty contact lenses. Students apply correct codes and modifiers to maximize appropriate reimbursement.

Lesson 2 • Diagnostic Testing Procedures

Covers codes for visual field testing, fundus photography, OCT, and corneal topography. Students match each test code to its documentation and medical necessity requirements.

Lesson 3 • Procedure Code System Overview

Introduces the structure of the procedure coding system, including its levels and modifiers. Establishes the framework students use throughout all subsequent procedure coding sections.

Lesson 4 • Surgical and Procedural Coding

Introduces codes for minor surgical procedures performed in optometry, including foreign body removal and punctal plugs. Connects surgical coding to global period and modifier rules.

Lesson 1 • Medical Decision-Making in Eye Care

Breaks down the three elements of medical decision-making as applied to ocular conditions. Students map clinical scenarios to the correct complexity level.

Lesson 2 • Documenting for E/M Compliance

Teaches documentation requirements that support each E/M level in optometry records. Connects documentation habits directly to audit-proof coding outcomes.

Lesson 3 • E/M Code Structure and Selection

Explains the office and outpatient E/M code set, its levels, and the two selection pathways. Provides the conceptual foundation for all E/M coding decisions in optometry.

Lesson 4 • Telehealth and Remote E/M Coding

Addresses E/M coding for synchronous telehealth and remote patient monitoring in optometry. Students apply correct place-of-service and modifier designations for virtual encounters.

Lesson 1 • Optical Goods Claim Submission

Walks through completing and submitting optical goods claims, including required attachments. Connects accurate code selection to clean claim submission and timely payment.

Lesson 2 • Frame and Low Vision Aid Billing

Addresses frame billing limits, low vision aid codes, and prosthetic eye coding. Students apply coverage limits and documentation requirements for each supply category.

Lesson 3 • Vision Plan Optical Benefits

Explains vision plan allowances, frequency limitations, and member cost-sharing for optical goods. Students calculate patient responsibility and bill correctly within plan parameters.

Lesson 4 • Supply Code System for Optical Goods

Introduces the alphanumeric supply code system used to bill frames, lenses, and accessories. Establishes the coding structure students apply throughout optical goods billing.

Lesson 1 • Electronic Claim Submission Process

Explains electronic data interchange standards, clearinghouse submission, and real-time eligibility checks. Students trace a claim from practice system to payer adjudication.

Lesson 2 • Charge Entry and Claim Creation

Covers charge capture, fee schedule setup, and claim creation in practice management systems. Accurate charge entry is the first step toward clean claim submission.

Lesson 3 • Remittance Advice Interpretation

Teaches students to read electronic and paper remittance advice documents and identify adjustment codes. Accurate interpretation drives correct payment posting and follow-up actions.

Lesson 4 • Payment Posting and Reconciliation

Covers posting insurance payments, patient payments, and contractual adjustments to accounts. Students balance daily deposits and identify posting errors before month-end close.

Lesson 1 • Working a Denial Effectively

Provides a step-by-step workflow for researching, correcting, and resubmitting denied claims. Students apply payer-specific rules to resolve denials within contractual timeframes.

Lesson 2 • Medical Necessity Appeals

Focuses on appealing medical necessity denials using clinical criteria, peer-reviewed literature, and payer policies. Students build evidence-based arguments aligned with payer review standards.

Lesson 3 • Denial Classification and Root Cause

Categorizes denials by type—eligibility, coding, medical necessity, and administrative—and identifies root causes. Accurate classification directs the correct resolution pathway.

Lesson 4 • Denial Trend Analysis and Prevention

Uses denial data to identify systemic billing problems and implement front-end corrections. Proactive prevention reduces denial volume and improves clean claim rates over time.

Lesson 1 • Revenue Integrity Metrics and Reporting

Introduces key performance indicators that measure billing health and revenue integrity. Students interpret dashboards and use data to drive continuous billing improvement.

Lesson 2 • Building a Billing Compliance Program

Outlines the seven elements of an effective compliance program adapted for optometry practices. Students draft policies, assign roles, and establish reporting mechanisms.

Lesson 3 • External Audit Preparedness

Prepares students to respond to payer audits, recovery audits, and government program reviews. Organized documentation and clear response protocols minimize financial exposure.

Lesson 4 • Internal Billing Audits

Teaches how to design and execute prospective and retrospective billing audits in optometry. Regular internal audits catch errors before external reviewers identify them.