With pandemic challenges, ensure you’re meeting your obligations

We are living in a time that is somewhat challenging for our teams. We are wearing masks all day, we are cleaning furiously to make certain any possible contamination of surfaces is erased, and we are doing everything we can to be efficient. So, we keep up standard of care, yet limit face-to-face time with any one person, all the while trying to maintain an outstanding patient experience. It is draining.

As I have talked to more and more of you, my colleagues, I am hearing the frustration of it all. The fogged up phoropter and 20D lens, your oculars on the slit lamp and just the overall change in protocol is exhausting, not to mention the worry of what to do when someone gets sick. With all this, it is normal to look for things to eliminate in our process to streamline the visit.

One step I know everyone is tempted to eliminate is dilation, especially if you can do widefield retinal imaging. Before you eliminate this step, please be aware of the guidelines, and do your research to be certain you are making the right decision.

STATE LAW

Start by looking at your state laws. Every state is different, and some have very strict requirements regarding dilation and what can and cannot substitute for dilation.

PROCEDURE CODE

Second, look back at the definitions in CPT from the American Medical Association and documentation guidelines of your 99000 and 92000 codes to see which require dilation and which do not. Make your decision on dilation based on what is medically necessary. However, if it is not medically necessary to dilate, be certain you use the correct level code, as described in the definition.

The 92000 codes, by definition, typically do not require dilation. However, they leave it to the doctor’s discretion. 99000 codes, by definition, may specifically mention dilation, depending on the level of coding.

INSURANCE REQUIREMENTS

Finally, check each insurance plan to see what is listed as specific requirements. (This includes all vision and medical plans.) Every insurance plan has a written description of what they require for your comprehensive and intermediate exam. Print out that description, as well as the unique audit sheets (if you can find them) to be certain you are meeting those requirements with what you are doing today in practice.

MEDICALLY NECESSARY

COVID-19 has not relaxed requirements for dilation for in-person visits, so continue to do as you have always done, and choose dilation as medically necessary. OM

DR. JASPER practices in West Palm Beach, Fla.. She is an American Academy of Optometry fellow and is chief optometric editor of Optometric Management. Email her at april.jasper@pentavisionmedia.com.