Billing and Coding the Medical Eye Exam, with Dr. Craig Thomas

[AdminWolf]

(audio starts 15 seconds in...)

A CEwire2015 highlight! @Laurence Craig Thomas gives us a great presentation on how to properly code and bill the medical eye exam.

A must-watch for all ODs who are doing medical billing.

If you've got any questions, feel free to post them here.

... and be on the lookout for an announcement about CEwire2016!

 

[Rahul M. Gupta]

Thank you, Dr. Thomas. I agree with many of the points made in this presentation, and I learned a few new things from it, as well.

I, too, find myself on the fence regarding 920x2 coding. To my sensibilities, it is the appropriate alternative to many 992x3 encounters, and its requirements are more pertinent to the vast majority of such examinations. However, the requisite that for 920x2, a problem be "complicated by a new" issue indeed is vexing. Depending on one's interpretation, for instance, it can preclude the evaluation of someone with A.M.D., naevus, glaucoma, P.V.D., etc., in which nothing "new" has developed (of course, the clinician would not know this prior to the completion of the examination).

I would say, for brief visits that I don't believe warrant 992x2 coding, the 992x2 encounter can be helpful. (This may be, for example, with respect to an I.O.P.-check conducted after a patient's glaucoma medicine has been changed.)

 

[Jeff Kiener]

"A must-hear. Two thumbs up!" --ODWire Critic Jeff Kiener.

 

[Rahul M. Gupta]

"A must-hear. Two thumbs up!" --ODWire Critic Jeff Kiener.

 

[AdminWolf]

"A must-hear. Two thumbs up!" --ODWire Critic Jeff Kiener.

lol, this was a good one, i'm posting a few of the CEwire2015 talks, where I can get the permission and rights from the authors. Hopefully it'll inspire people to sign up for the next show!

thanks
adam

 

[Paul Farkas]

lol, this was a good one, i'm posting a few of the CEwire2015 talks, where I can get the permission and rights from the authors. Hopefully it'll inspire people to sign up for the next show!

thanks
adam

What gets me is the standing room only audiences at Vision Expo West. ODs spending 11 hours in class. What's the attraction when this quality education can be received from the comfort of your home or office?

 

[AdminWolf]

What gets me is the standing room only audiences at Vision Expo West. ODs spending 11 hours in class. What's the attraction when this quality education can be received from the comfort of your home or office?

VEW had a pretty wide variety of courses, so I can see the appeal for sure. My issue is that the education runs parallel to the exhibits, and as an attendee you've only got so many hours in the day. So something has to give.

 

[Nick Weber]

Paul,

It's all about "Vegas, Baby!" It is a 30% discount for travel to an entertainment filled destination.

 

[John Boer]

Paul,

It's all about "Vegas, Baby!" It is a 30% discount for travel to an entertainment filled destination.

Yeah, but having to spend all that time with other ODs? No thanks.

 

[Nick Weber]

Yeah, but having to spend all that time with other ODs? No thanks.

Damn bunch of losers.

BTW, I spend as little time as possible with the other OD's. As soon as you exit the classes, its off to escorts, strippers, and blackjack tables.

 

[Frederick Frost]

VEW had a pretty wide variety of courses, so I can see the appeal for sure. My issue is that the education runs parallel to the exhibits, and as an attendee you've only got so many hours in the day. So something has to give.

The hours of the exhibit hall was a definite problem. I arrived on Saturday morning and my first class did not start until 945, only to find exhibit hall did not open till 9:30 AM. So I had 15 minutes and I spent it with one vendor.

While there were adequate hours to sneak in between classes, due to the poor facilities of not having power outlets or tables, I found myself constantly trying to find outlets to keep my electronic devices charged so I can take the kind of notes I'm I'm used to taking. Thus the exhibit hall time suffered. In order to make sure I had a seat after the debacle of the anterior segment class, I arrived to the two other classes in that lecture hall, half an hour early just to be sure I would get a seat. In every class in that room, someone did not have a seat.

The vision expo application however did provide good information including contact information for any of the companies that I missed, so I can contact them as well as visit their website to learn about the products.

As far as talking to other OD's, some of the best doctors in our profession were present, and it was a great opportunity to network if you wanted to.

 

[h.c. jang]

The hours of the exhibit hall was a definite problem. I arrived on Saturday morning and my first class did not start until 945, only to find exhibit hall did not open till 9:30 AM. So I had 15 minutes and I spent it with one vendor.

While there were adequate hours to sneak in between classes, due to the poor facilities of not having power outlets or tables, I found myself constantly trying to find outlets to keep my electronic devices charged so I can take the kind of notes I'm I'm used to taking. Thus the exhibit hall time suffered. In order to make sure I had a seat after the debacle of the anterior segment class, I arrived to the two other classes in that lecture hall, half an hour early just to be sure I would get a seat. In every class in that room, someone did not have a seat.

The vision expo application however did provide good information including contact information for any of the companies that I missed, so I can contact them as well as visit their website to learn about the products.

As far as talking to other OD's, some of the best doctors in our profession were present, and it was a great opportunity to network if you wanted to.

Fred stop complaining! Yeah.. that happened to me once. Uh... what do you mean I can't see the show until 9:30? I have a class in 15min. You have lectures starting at 7am. Maybe I can use the extra 2 hours I have to buy coffee and MAYBE I might get back in time. BTW, I love having to walk into a crowd of ODs trying to get in and out of classes all at the same time. I now know what cattle going to the slaughter feel like. Don't get me started on getting course handout printouts.

It would have been fun bitching together there.

 

[AdminWolf]

Fred stop complaining! Yeah.. that happened to me once. Uh... what do you mean I can't see the show until 9:30? I have a class in 15min. You have lectures starting at 7am. Maybe I can use the extra 2 hours I have to buy coffee and MAYBE I might get back in time. BTW, I love having to walk into a crowd of ODs trying to get in and out of classes all at the same time. I now know what cattle going to the slaughter feel like. Don't get me started on getting course handout printouts.

It would have been fun bitching together there.

This is an even bigger problem than you realize; I spend much of my days at these events meeting with execs at the different companies, and their chief complaint is that it is feast-or-famine in the exhibit halls, usually due to other events going on simultaneously.

I have often wondered why they don't extend the halls hours even further. Vendors have gone through incredible expense to be there. Even the crappiest booth will cost a vendor $5-10k when all is said and done, and the giant monstrosities -- between the shipping, teamsters, power, and manpower needed to run the things -- can be in the six figures, all-in. No joke.)

So adding an extra couple of hours in the morning and running at times when there are no classes would seem to be a logical step. There must be a reason why it isn't done.

 

[Nick Weber]

No one shows up then either...

 

[AdminWolf]

No one shows up then either...

I'm not that cynical

The exhibit halls are crowded during certain very limited times of day -- this is stressful both for show-goers, and for the vendors. If those 'prime times' could be spread out a little more, it would make for better service.

 

[h.c. jang]

This is an even bigger problem than you realize; I spend much of my days at these events meeting with execs at the different companies, and their chief complaint is that it is feast-or-famine in the exhibit halls, usually due to other events going on simultaneously.

I have often wondered why they don't extend the halls hours even further. Vendors have gone through incredible expense to be there. Even the crappiest booth will cost a vendor $5-10k when all is said and done, and the giant monstrosities -- between the shipping, teamsters, power, and manpower needed to run the things -- can be in the six figures, all-in. No joke.)

So adding an extra couple of hours in the morning and running at times when there are no classes would seem to be a logical step. There must be a reason why it isn't done.

I've been on both sides. And you're right, it ain't cheap. And I gree, it seems like it's so busy you can't get someone to talk to you or you can hear crickets. I don't know if it's even worth it for some of the smaller companies and it's a shame because it used to be you can see some new players and new things. And is it just me or do some of these bigger companies have people that just stand around and talk to themselves rather than greet people? I don't remember it being this bad a few years ago.

And I get what Fred is saying. Education ain't cheap but we seem to be squeezed into these rooms like sardines for one thing. At least upgrade the chairs. You can't sit without hitting the person next to you if you're lucky enough to get a chair. Sometimes I sit on the floor because it's more comfortable.

 

[Paul Farkas]

I've been on both sides. And you're right, it ain't cheap. And I gree, it seems like it's so busy you can't get someone to talk to you or you can hear crickets. I don't know if it's even worth it for some of the smaller companies and it's a shame because it used to be you can see some new players and new things. And is it just me or do some of these bigger companies have people that just stand around and talk to themselves rather than greet people? I don't remember it being this bad a few years ago.

And I get what Fred is saying. Education ain't cheap but we seem to be squeezed into these rooms like sardines for one thing. At least upgrade the chairs. You can't sit without hitting the person next to you if you're lucky enough to get a chair. Sometimes I sit on the floor because it's more comfortable.

Could it be that CEwire2016 is an idea whose time has come?

If only the State Boards would cooperate by loosening up their CE requirements.

 

[Agustin Gonzalez]

"all eye examinations are medical eye exams".

 

[Steven Nelson]

View attachment 8020

"all eye examinations are medical eye exams".

I agree with this in theory, but the problem is that the insurance companies don't. They do their best to carve out as much "wellness" as possible to either outright deny claims or pass it off to some other terrible payer.

This could be fixed tomorrow by making refractive error medically valid diagnoses and just assigning them mid-level reimbursement status based on the medical decision making...but that would result in a basic total deconstruction of the vision plans and put them back in the business of just covering materials and that would be their death, so it'll never happen.

 

[Joe DiGiorgio O.D.]

escorts, strippers, and blackjack tables.

Can you get a stripper to escort you to the blackjack table? How can Paul compete with that? I am sure he can get you a good deal on some excellent Pinot.

 

[Rahul M. Gupta]

Damn bunch of losers.

BTW, I spend as little time as possible with the other OD's. As soon as you exit the classes, its off to escorts, strippers, and blackjack tables.

Sounds like any other Wednesday.

 

[Kevin J. Gross OD]

Dr. Thomas, I do record a 'general medical observation' for my encounters, but unless there is something to record such as 'wheelchair bound' or 'using a walker' ect., I'll simply record 'unremarkable'. A notation is made, but would it be advisable to extend the note into something like what you are using?

 

[Kevin J. Gross OD]

Second question: In the case of cataracts, and assuming no refraction was performed, would 'Follow cataracts conservatively' suffice for a treatment plan?

 

[Steve Silberberg]

Second question: In the case of cataracts, and assuming no refraction was performed, would 'Follow cataracts conservatively' suffice for a treatment plan?

How do you follow a cataract aggressively rather then conservatively

 

[Kevin J. Gross OD]

How do you follow a cataract aggressively rather then conservatively

It's a phrase I borrowed from our retinologist Steve, he likes to use it a lot. I suppose it's another way of saying 'no treatment indicated at this time but condition requires monitoring'. I noticed that 'monitor' was on the list of treatment plans on the slide in Dr. Thomas' presentation.