Optometric Invoicing and Coding Vocabulary

This set covers the classification systems (ICD-10, ICD-11) and the optometric tariff coding procedures used for professional billing and invoicing.

International Classification of Diseases (ICD)

The diagnostic classification standard for all clinical and research purposes used for systematic recording, reporting, analysis, and interpretation of mortality and morbidity data.

ICD-10

The 10th revision consisting of a single coded list of three-character alpha-numerical categories, where the first position is a letter and the following positions are numbers.

ICD-11

The latest revision released in 2019 (effective January 2022) which uses four-character category codes with an alpha-character in the second position and a number in the third position.

Chapter VII (ICD-10)

The chapter dedicated to Diseases of the eye and adnexa, covering codes $H00-H59$.

H52

The ICD-10 category for disorders of refraction and accommodation.

H52.0

The specific ICD-10 code for Hypermetropia.

H52.1

The specific ICD-10 code for Myopia.

H52.2

The specific ICD-10 code for Astigmatism.

H52.4

The specific ICD-10 code for Presbyopia.

Z01.0

The ICD-10 code for Eye test/Consultation.

Z97.3

The ICD-10 code indicating the presence of spectacles.

Tariff Code

A unique code assigned to every type of product or service in the optometric industry for invoicing purposes.

Optical Assistant SBMEDIA

An online reference and guideline tariff for professional services and lenses, accredited by the Health Professions Council of South Africa (HPCSA).

Tariff Code: First Character (Lenses)

Identifies the material of the lens, where #7 indicates Glass and #8 indicates Plastic.

Tariff Code: Second Character (Lenses)

Identifies the lens category: 1 for SV stock, 2 for SV surfaced, 3 for Accommodative support, 4 for Bifocal, 5 for Varifocal Intermediate/Near, 6 for Varifocal Distance/Near, and 7 for Add on.

Rule 1 (Per Eye)

A billing rule indicating that a procedure is charged per eye and can be charged twice for some procedures.

Rule 2 (Can charge in isolation)

A billing rule indicating that a procedure can be charged independently without performing a full optometric examination ($110^{**}$ range).

11001

The optometric tariff code for a standard Optometric Examination.

11081

The optometric tariff code for an Optometric Examination combined with Visual Field Screening.

RVU

Relative Value Units, used within the SAOA Procedures and Coding Manual to enable appropriate billing for procedures.