Practice Management And Low Vision Flashcards
Financial considerations for low vision
Starting up Billing and coding -diagnosis -eval -refraction -training Materials -insurance -resources
Practice setting: starting up
- University Vs hospital vs private proactive
- alotted time
- using techs
- billing assistance
Charts: starting up
VA, contrast, reading, peds vs adutls
Things to think about when starting up
Practice setting Charts Visual fields Miscellaneous equipment Devices
Charts: starting up
ETDRS Feinbloom Lea shapes Collenbrander near chart Continuous text cards (MNRead) MARS perceptrix (contrast) Hiding Heidi (contrast)
Visual fields
Arc perimetry HVF -standard -120 point -esterman binocular Goldman Octopus Microperimeter (MAIA)
Other essential equipment for starting up low vision
Trial frames
Trial lenses
JCC lenses
Tint samples
Near devices to demonstrate
- HHM (illuminated and non illuminated)
- stand magnifiers
- dome magnifiers
- microscopic/half eyes
Intermediate devices to demonstrate in low vision
Telescopes
- max detail
- spec mounted
- Beechers
Distance devices to demonstrate
Telescope
- hand held
- spec mounted
Electronic devices to demonstrate in low vision
Portable hand held CCTV
Portable desktop CCTV
Desktop CCTV
Medical insurance and low vision
Will cover evaluation -includes Medicaid and Medicare Typically covers OT services Does not cover devices or glasses -exception after cataract glasses
Vision insurance and low vision
Can be used for glasses and CL
Typically does not cover devices
-exception: some VSP plans
Diagnosis codes and low vision
-Medical diagnosis listed first
-ACD-10 codes for visual impairment
-if patient does not qualify for VI code can use visual field defect, contrast loss, symptom codes, etc
—OT can use contrast or VF codes
—OT typically cannot use symptom codes
Mild or no visual impairment
Equal to or better than 20/70
Moderate visual impairment
Worse than 20/70
Equal to or better than 20/200
Severe visual impairment (2)
Worse than 20/00 but equal to or better than 20/400
Blindness cat 3
Worse than 20/400 but equal to or better than 20/1200 (5/300)
Blindness cat 4
Worse than 20/1200 (5/30) but better than or equal to light perception
Blindness cat 5
No light perception
Blindness cat 9
Undetermined or unspecified
Notes on visual impairment codes
- a Pearson with low vision is one who has impairment of visual functioning even after treatment and/or standard refractive correction, and has a visual acuity of less than 6/18 to logistical perception, or a VF of less than 10 degrees from the point of fixation, but who uses, or is potentially able to use, vision for planning and/or execution of task
- measured as entering acuity: takes into account VI due to uncorrected RE
- when visual fields taken into account, pateitns with VF in better eye no greater than 10 in radius around central fixation should be placed under category 3
E/M codes
- traditional use
- billing on time
- prolonged service
Consultation codes
In patient consultations In office -certain requirements needed in chart -documentation of correspondence -not applicable to Medicare
99203
New
Detailed Hx
Exam: detailed, 9-13 elements
Medical decision: low
99204
New
Comprehensive Hx
Exam: comprehensive-14 elements
Medical decision: moderate
99213
Established
Exp problem focused Hx
Exp problem focused exam: 6-8 elements
Medical decision: low
99214
Established
Detailed Hx
Detailed exam-9-13 elements
Medical decision: moderate
How many elements are required on new patients
3/3
How many elements are required on established patients
2/3
New patient, comprehensive history, detailed exam, moderate decision making
There are 2 things from 99204, and one thing from 99203, but it has to be coded as a 99203 because you didnt meet the 3/3 elements for the patient
Prolonged service codes
99354
- are able to be used when face to face physician time exceeds limits outlined in CPR
- not applicable to students
Billing on time
When counseling and/or coordination of care do I cates (more than 50%) the encounter with the patient and/or family (face to face time in the office or other outpatiet setting..) then time shall be considered the key or controlling factor to qualify for a particular level of E/M services. This includes time spent with parties who have assumed responsibility for the care of the patient or decision making, whether or not they are family members. The extend of counseling and/or coordination of care must be documented in the medical record
Documentation for billing on time
Start time: X refraction stat time: X refraction end time X end time: X
Consultation codes
- Medicare does not cover consultation codes. This is why we dont usually use these
- need a proper referral from referring physician
- need to send correspondence back to the referring physician
- in patient consultation and out patient consultation codes
Outpatient consultation codes
Key component for office of other outpatient consultation, all 3 are needed for selecting correct code
Hospital in patient services-subsequent care
- all subsequent levels of service including reviewing the medical record, diagnostic studies, and changes in the pateitn status, such as history, physical condition, and repsosne to treatemtn since the last assessment
- 2/3 components needed to select correct code
In patient consultation codes
- these codes are for hospital inpatietns, residents of nursing facilities in a partial hospital setting
- al three components needed for selecting correct code
Ancillary testing
Not included in time
- VF (including arc perimeter)
- micorperietry
- OCT
- color vision
- refraction
Refraction and medical insurance
Not covered by medical insurance (except KY Medicaid)
- can bill vision insurance
- typically out of potency cost to the patient
- can set own fees for complexity. Good to let patients know this in advance
Training codes
Physical medicine and rehab codes
- 9735: self care/home managment training
- 97530: therapeutic activities
- 97537: community work/reintegration
physical medicine and rehab code: 97535
- 1 unit=15m increments
- self care/home management training
- training on use of devices, non optical aides, etc
Physical medicine and rehab code 97530
1 unit=15m increments
Therapeutic activities
Train on eccentric viewing, visual field awareness/ scannning
Physical medication and rehab code 97537
1 unit=15m increments
- community/work integration training
- shopping, transportiona, Money management, task modification, lighting, etc
Guidelines for training codes
- typically OT and PT; can be used by physicians or OD
- document separate and distinct goals and treaemtn plans
- patient must have capacity to learn from instruction
- must discontinue if no improvement with 2 sessions
- must not exceed 8 visits in 90 days
Materials for low vision and insurance
Not covered by Medicare or Medicaid -typically not covered by private insurance -some VSP plans provide coverage —$1000 every 2 years — 75% coverage, pt responsible for 25% —have to accept VSP at your office to use this Can mark up devices per your discretion -MSRP is typically provided by supplier
Materials assistance
Lions club
KYOB
Vocational rehab
Financing options
