WHAT ARE THE NECESSARY ELEMENTS FOR CODING THE ANTERIOR SEGMENT?

IN THE eye care business, there are topics the primary eye care practitioner must be aware of: refractive disease, dry eye, allergy, glaucoma, myopia reduction, macular degeneration, specialty contact lenses, just to name a few. It is difficult to maintain a well-equipped office that can employ the technology to appropriately examine, diagnose and treat patients to the higher standard of care that exists today, under the framework of outcome-based care.

Also understand your practice is a business that employs many resources — human capital, represented by staff; clinical capital, represented by your intellectual property, and financial capital, represented by your facilities and technology. It is incumbent on you to properly manage all of these resources to provide the best patient experience, clinical outcomes and financial return all while minimizing the inherent risk that comes with malpractice and medical record compliance.

DO WHAT’S NECESSARY – DON’T EMBELLISH

Specific to the anterior segment, many new point-of-care tests, diagnostic tests and clinical treatments assist us in providing efficient and effective care. However, we can be swept up in the trend of doing everything on every body – first just to ensure we don’t miss anything and second to embellish the medical record and enhance revenues. Don’t fall for this temptation.

To provide proper clinical care means being a great investigator; listen carefully and examine prudently. Properly record any complaints or symptoms of eye disease or injury provided by the patient and record any clinical findings that you discover in your examination and subsequent diagnosis. Whether patient directed or physician directed, these points are critical to comply with the chief complaint requirement.

Of equal importance is medical necessity. Don’t be lulled into complacency by feeling omnipotent in being able to do anything you want to do just because you want to or you heard about in a lecture or journal. This applies to special ophthalmic tests and clinical procedures you perform; medical necessity also dictates to the level of the encounter. Specifically, patient’s presentation determines the level of history you perform, the level of history dictates the level of physical examination you perform and the combination of these, with your clinical results, determine the medical decision making done to determine the proper level of the office visit.

UNDERSTAND NATIONAL GUIDELINES VS. LOCAL RULES

Keep in mind that your local (zip code specific) rules must be adhered to when performing your clinical tests along with fulfillment of all CPT and ICD rule sets. If you’re not familiar with them, then some homework is in order so compliance isn’t a guess or some form of luck – there is too much to risk in today’s world. One resource for this could be CodeSAFEPLUS.com .

MANAGE RESOURCES PROPERLY

Managing a busy eye care practice is a challenge in today’s world – utilizing your resources effectively while providing a great patient experience and outcomes is no easy task. State boards of optometry need to take a good hard look at the current and future environment and help our profession flourish – the demand for eye care services is growing far too quickly for our laws and administrative rules to fall behind. We need to understand that in the future – we need to be firmly entrenched in the belief that we are data analyzers, not data gatherers so we can provide the very best care we are trained to do. 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..