anterior

Utilizing Anterior Segment Diagnostic Equipment

Here’s what you need to know before investing in this technology.

CHARLES W. FICCO, O.D., MORROW, GA. MARY ELIZABETH F. BRICE, O.D., DUNWOODY, GA.

Utilizing anterior segment diagnostic technology allows you to differentiate your practice, which is more important than ever in the current landscape of healthcare. Optometrists are inherently ocular surface disease experts, so it is natural for us to take advantage of this expertise and use the most up-to-date anterior segment diagnostic technology to maximize the care of our patients.

Remaining knowledgeable on this technology not only improves the quality of care for your patients, but it also can put more money in your pocket through reimbursements when billed properly and patient referrals.

Let’s review the most important anterior segment diagnostic technologies you may want to consider adding to your practice.

Non-invasive tear osmolarity test

Why purchase?: Tear Lab, Inc., has developed a non-invasive test to determine a patient’s tear osmolarity, which is valuable in the diagnosis of dysfunctional tear syndrome. Although osmolarity is not a specific marker for the type of dysfunctional tear syndrome a patient may have, it is an excellent way to show a patient their “number” and the presence of the disease. Also, it is helpful to show a patient’s progress through treatment.¹

How to perform test: A small tear sample at the temporal canthus is all that is needed to perform the test. The test is Clinical Laboratory Improvement Amendments (CLIA)-waived, which means you can perform it as a “lab test” in your office without needing to be CLIA certified.

Corneal topographers are imperative for high astigmatism, any corneal irregularity or pre/post-refractive surgery patients.

Billing: It is reimbursed through the Center for Medicare/Medicaid Services (CMS) at a rate of roughly $46.00 per patient, or $23.00 per eye. The ICD-9 code is 83861.^2,3

Viral conjunctivitis test

Why purchase?: AdenoPlus, from RPS, inc. is a 10-minute test that detects the presence of Adenovirus hexon proteins in conjunctival tear samples. The test needs to be performed within seven days of development of symptoms, and inadequate sample collection will yield false negative results.^4,5 This test is CLIA-waived as well. In clinical trials, the test had 90% sensitivity and 96% specificity.⁶

How to perform test: AdenoPlus is a swab that is dragged across the palpebral conjunctiva six to eight times then held in place for an additional five seconds. The sampling fleece is then placed in buffer vial for 20 seconds and left on a flat surface for 10 minutes. It is read positive if the test window reveals two colored lines, a blue control line and a red positive result line.⁷

Billing: The Healthcare Common Procedure Coding System (HCPCS) billing code for the AdenoPlus test is 87809QW and the 2013 rate is $16.49.^2,3

Pachymeters

Why purchase?: Pachymeters are used when co-managing refractive or cataract surgery or treating glaucoma patients. There are numerous designs available, including the ability to measure central corneal thickness (CCT) with the OCT. Knowing the CCT of patients who are glaucoma suspects or ocular hypertensives gives you that extra “piece of the puzzle” you may need to make sound clinical decisions. In patients with corneal dystrophies (i.e. Fuch’s dystrophy) and subsequent corneal thickening, the pachymeter is essential in determining whether patients are candidates for a DSAEK procedure or a triple procedure if they have visually significant cataracts.

How to perform test: Testing is performed with a topical anesthetic. The probe is held perpendicular and gently pressed against the central cornea. Several measurements are taken, and an average of these measurements gives you the CCT.

Billing: These instruments are generally less than $500 and reimbursement through CMS is approximately $15 per eye. The ICD-9 code is 76514, and it is billed as a unilateral procedure.^2,3

Dynamic contact tonometer (DCT)

Why purchase?: The DCT is well-suited for cases of irregular corneas and for patients who are status post-refractive surgery.^8,9

How to perform test: The tonometer has a special probe that makes momentary contact with the cornea for an accurate and reproducible IOP measurement. It does not require anesthesia.

Billing: This instrument costs roughly $2,500 to $3,000. There is no separate reimbursement for DCT, although its clinical benefit to your glaucoma patients with irregular corneas make the investment worthwhile.^2,3

Corneal topographer

Why purchase?: For any patient with high astigmatism or any corneal irregularity or patients who are pre/post-refractive surgery, a routine topography is imperative. Topographers also aid in the fitting of RGP, soft and orthokeratology lenses. More advanced topographers are available that meticulously map the anterior and posterior surface of the entire cornea as well as measure central and peripheral corneal thickness.

How to perform test: The patient is aligned, fixates on a target, and the machine does all the work.

Billing: The ICD-9 code is 92025, and the reimbursement is roughly $39.00.^2,3

Anterior segment camera

Why purchase?: In our litigious society, you must protect yourself against frivolous lawsuits. Nothing compares to an actual picture of anterior segment pathology. Photography also allows you to communicate more efficiently with referral doctors and gives you proper documentation for your treatment strategies.

How to perform test: Some slit lamps come with the camera installed, while others can be mounted to an adapter. Most connect to a computer terminal or hook into a central database.

Billing: The ICD-9 code is 92250, and the reimbursement is roughly $73.00. The initial cost can range from hundreds to thousands of dollars depending on the system. But if you use it wisely, you will recoup your costs within the first year. You must have an initiation of treatment, referral or a change in treatment to legally bill for photos. Also, you must have an interpretation and report documented in your chart. This is a separate document detailing the interpretation, assessment and plan for the patient.^2,3

On the front line

Investing in the latest anterior segment diagnostic technology enables you to diagnose, treat and manage your patients more thoroughly. In addition, patients perceive you as being more knowledgeable and on the cutting edge. This increases revenue through reimbursements and grow your patient base through referrals. OM

References are available in the online version of this article at optometricmanagement.com.

	Dr. Ficco is the clinic director at Clayton Eye Center in Morrow, Ga. His practice centers around anterior segment pathology and surgical co-management of cataract, refractive and retinal surgery. E-mail him at charficco@aol.com.
	Dr. Brice is an associate at Briggs Vision Group, a private practice in Dunwoody, Ga. She is currently vice president of the Greater Atlanta Optometric Association. E-mail her at bricemaryelizabeth@yahoo.com, or send comments to optometricmanagement@gmail.com.