BUSINESS

  CODING STRATEGY

DIAGNOSTIC TESTING

WHEN ‘JUST ENOUGH’ MAY BE TOO MUCH

JOHN RUMPAKIS, O.D., M.B.A.

DIAGNOSTIC EYE care technology has been advancing at a rapid rate. The exhibit hall floors are dotted with companies demonstrating how their technology can make the clinical care you provide more advanced, more efficient and more effective. I believe the progress we are making is a wonderful thing. These innovations allow us not only to accurately assess the current health state of the eyes and visual system, but also to possibly predict changes in the future. However, when employing this technology, the doctor’s medical records are generally inadequate to justify a particular test or procedure.

PRACTICE BEHAVIOR ANALYSIS

For far too long, enhancing reimbursement has been the driving force for many of the clinical diagnostic tests performed in optometric practices. The risk that this exposes the individual doctor and practice to is far too great in this era of coding analysis, comparative billing reports and ICD-10. If you are not convinced that the federal government, state governments, commercial carriers (both medical and managed vision care alike) and public interest groups are analyzing your practice behaviors and comparing you to the standard of care, and your local and national peer group, perhaps a visit to a site, such as ProPublica.org, would be in your best interest. This public site, like many others, clearly shows that your individual testing habits (amongst many other things) is being tracked, analyzed and flagged for aberrant behavior. The specific URL that I would encourage you to review is projects.propublica.org/treatment/ and then simply type in your name and state. Do I have your attention now?

PROPER DOCUMENTATION

Herein lies the issue at hand. Diagnostic technology is wonderful and I truly hope that the speed of innovation does not slow down because it truly does help us do our jobs better. That being said, we have to do a much, much better job of making sure that we are properly documenting the medical record. It needs to clearly establish the medical necessity of the test and to indicate why the test is going to allow a better outcome for the patient, via enhanced management of the condition. Doing a test simply because “the diagnosis was covered” is woefully inadequate reason in today’s world. Most audit failures for special ophthalmic procedures are generated: by not providing adequate or appropriate medical necessity for performing the test in the medical record and by simply testing because you want to do the test or to provide a baseline of normalcy.

Diagnostic testing will continue to be a big part of eye care practices. Just remember that the tests should enhance your clinical skills when they are necessary to perform; they should not replace you as the clinician. For example, performing a retinal screening photo is not a legal substitution for performing a dilated fundus examination. They are not, nor will they ever be, equivalent procedures.

USE RESPONSIBLY

Judicious and appropriate use of diagnostic technology will continue to propel our practices into the future and allow us to deliver more efficient and effective diagnosis and management of our patients. Just follow the rules and use it when necessary. OM

DR. RUMPAKIS is founder, president and CEO of Practice Resource Management, Inc., a consulting, appraisal and management firm for healthcare professionals. Email him at John@PRMI.com, or visit tinyurl.com/OMcomment to comment on this article.