Optometry billing automation that starts in the exam chart.
Doctora drafts the ICD-10 and CPT codes from the exam the doctor just charted, with modifiers and each code tied to the finding that supports it. The doctor confirms every code before the chart is sent to the EHR, so the claim starts clean. Eligibility checks and claims are separate rows with their own status.
- CodingLive
- Insurance eligibilityBeta
- ClaimsPilot by invitation
ICD-10 and CPT coding from the chart, confirmed by the doctor.
Billing optimization here means coding what was done. Codes are drafted only from what was charted, and nothing is final until the doctor says so.
ICD-10 and CPT with modifiers
Diagnosis codes and procedure codes, including right-eye, left-eye and same-day modifiers, suggested from what was charted. Each CPT line names the diagnosis that justifies it.
Every test charted gets its code
Each test performed and charted, such as OCT, fundus photos or visual fields, gets its own CPT code drafted, so performed work is not left off the bill.
New or established, from the records
The exam code (92004 or 92014, 92002 or 92012, 99204 or 99214) follows what the patient's own records show. A standing preference cannot override it.
Cataract post-op
A visit inside the global period after cataract surgery is recognized from the booked exam type or from the prior surgery. It is coded 66984-55, the post-operative care, with no separate eye exam code. A practice can turn this off.
Learns the doctor
Coding preferences the doctor has confirmed before, and the diagnoses from prior visits, shape the next suggestion.
Refraction
Whether 92015 is added for a refraction is a rule the practice sets per exam type.
Clean claims start with the coding.
Many claim denials trace back to the coding: a service with no diagnosis, the wrong eye, the wrong exam code, coverage nobody checked. Each one has an answer on the chart.
A service with no diagnosis
Each CPT line names the diagnosis that justifies it, so every service has its diagnosis when the chart is sent.
The wrong eye
Right-eye, left-eye and same-day modifiers are drafted from what was charted for each eye, for the doctor to confirm.
The wrong exam code
New or established follows the patient's own records, not the appointment name or a standing preference.
A post-op billed as an exam
A visit inside the cataract global period is coded 66984-55, with no separate eye exam code.
Coverage nobody checked
The patient's vision plan and medical plan can be checked before the visit, with what each payer reports side by side.
A claim with a gap
For practices we have invited to submit claims from Doctora, each claim is checked before it goes out: a service line with no diagnosis, an invalid code, a missing member ID, or an eye exam code and an office visit code on the same date.
Payers and fee schedules.
What the practice's own EHR has billed, and what the staff know about each payer, next to the chart being coded.
Fee schedules from your own sales history
Fee schedules are pulled from the practice's own EHR sales history and confirmed by staff.
Last billed visits by payer
The patient's last three exam visits as the EHR invoiced them, payer by payer: codes, payments applied and balance.
Payer notes
What staff know about a payer, shown to the doctor beside the routine or medical choice.
Last billed
exam visits, this patientMed / Refr / Exam describe the line's ICD-10 codes (H52.* refractive, Z01.0* eye exam, else medical), never the visit. A dotted code means its diagnoses were not read or none is linked.
Amounts are what each payer applied to the exam lines as RevolutionEHR invoiced them. Materials are never counted. A dash means not read, not $0.
- Mar 3, 2025+ materials: VSP: $130.00 applied to materials (not counted)VSP$125.00Patient$25.00Balance$0.00
Paid in full · VSP · patient $25.00 · settled Mar 14, 2025 · of $150.00 billed
VSPprimary- Mar 3, 2025S0621 charged $110.00
- Mar 3, 202592015 charged $40.00
- Mar 14, 2025S0621 paid $85.00
- Mar 14, 202592015 paid $40.00
Patientpatient- Mar 3, 2025S0621 patient paid $25.00
- Mar 3, 202592015 patient paid $0.00
MaterialsVSP: $130.00 applied to materials (not counted) - Mar 12, 2024Blue Cross$179.57Patient$44.89Balance$0.00
- Mar 20, 2023VSP$55.00Patient$40.00Balance$0.00
Sample data. Fictional patient and amounts.
Eligibility, before the visit.
Doctora checks the patient's vision plan and medical plan and shows what each payer reports, side by side, for the visit date. The practice runs the checks from one worklist, for one patient or for the day's schedule, and the worklist sorts by who needs a call.
Claims and claim status, for practices we have invited.
Claims are built from the coded chart, checked before they go out and submitted from Doctora. Each claim's status follows it back: accepted or rejected, then paid or denied. Ask us if your practice wants in.
Where Doctora fits in the revenue cycle, from eligibility to payment.
RCM is the path exam revenue takes, from the eligibility check before the visit to the payment after it. Doctora covers the front of it, and each part carries its own status.
Before the visit: eligibility
The vision plan and the medical plan checked for the visit date, with what each payer reports side by side.
In the exam: coding
ICD-10 and CPT codes drafted from the chart, each linked to its diagnosis, for the doctor to confirm.
After the exam: into the EHR
The confirmed chart and its codes go into the EHR the practice already bills from.
The claim
Built from the coded chart, checked before it goes out and followed through to paid or denied, for practices we have invited.
How it fits the day.
The doctor
Confirms the codes on the chart, next to the findings that support them, before the chart is sent to the EHR.
The biller
Sees the coded chart, the payer history and the benefits for the visit in one place, and works denials and appeals the way they do today.
The practice
Keeps its billing company or its in-house biller. Doctora codes the exam, and the claim goes out the way it does today unless the practice is one we have invited to submit claims from Doctora.
What practices ask about billing.
How does Doctora help prevent claim denials?
By getting the coding right on the chart. Each CPT line names the diagnosis that justifies it, eye modifiers come from what was charted for each eye, the new or established code follows the patient's records, and eligibility can be checked before the visit. Practices we have invited to submit claims from Doctora also get a check on each claim before it goes out. A denial still depends on the payer and the plan, and Doctora does not promise a denial rate.
How does it handle medical vs vision billing?
The doctor and the biller decide. Doctora shows the payer-reported benefits for the vision plan and the medical plan side by side, and never picks the plan to bill or whether a visit is routine or medical. The codes are suggestions the doctor confirms.
Does it work with my billing company?
Yes. Doctora codes the exam on the chart, and whoever submits your claims keeps doing so, unless your practice is one we have invited to submit claims from Doctora.
Is Doctora a billing service?
No. Doctora is billing software for the practice, not a billing company. It codes the exam, checks eligibility and shows the payer history, and your own staff or billing company keep working the claims, unless your practice is one we have invited to submit claims from Doctora.
What is revenue cycle management (RCM) for optometry?
RCM is everything between booking a patient and collecting for the visit: eligibility, coding, the claim, payment and denial follow-up. Doctora covers the front of it, with eligibility before the visit and coding from the chart, and claims for practices we have invited.
Do I need to change my EHR to get coding?
No. Coding comes with the scribe for every EHR Doctora writes into: six optometry EHRs today, RevolutionEHR, Eyefinity EHR (Encompass), Eye Cloud Pro, CrystalPM, OfficeMate/ExamWRITER and Uprise (VisionWeb). The confirmed codes go into the EHR with the chart.
Can I review and change the codes before billing?
Yes. Every suggested code is editable on the chart, and the doctor confirms the codes before the chart is sent to the EHR.
Will it reduce my audit risk?
Every code sits next to the finding that supports it, and codes are drafted only from what was charted, so the documentation behind a claim is the exam itself. What holds up in an audit still depends on what was done and documented.
How much revenue can it recover?
We do not publish a recovery figure, because it depends on how the practice codes today. What changes is that each test charted, such as OCT, fundus photos or visual fields, gets its own code drafted, and the exam code follows the patient's records, so performed work is less likely to be left off the bill.
Is it HIPAA compliant?
Yes. Doctora is HIPAA compliant and signs a business associate agreement (BAA).
What does Beta mean?
Beta means the feature is built and running in practices that asked for it. It is included where your plan lists it; we turn it on with you, and it may change as practices use it.
See your own exam coded.
Book a demo and see the codes, the findings behind them and the payer history on a sample chart. Try Doctora free for your first 10 charts.
Per doctor, month to month or annual. HIPAA compliant, with a signed BAA.