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3F: Low Vision Final > Practice Management And Low Vision > Flashcards

Practice Management And Low Vision Flashcards

1
Q

Financial considerations for low vision

A 
Starting up 
Billing and coding 
-diagnosis 
-eval
-refraction
-training
Materials 
-insurance 
-resources
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2
Q

Practice setting: starting up

A
  • University Vs hospital vs private proactive
  • alotted time
  • using techs
  • billing assistance
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3
Q

Charts: starting up

A

VA, contrast, reading, peds vs adutls

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4
Q

Things to think about when starting up

A 
Practice setting 
Charts
Visual fields
Miscellaneous equipment
Devices
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5
Q

Charts: starting up

A 
ETDRS
Feinbloom
Lea shapes
Collenbrander near chart 
Continuous text cards (MNRead)
MARS perceptrix (contrast)
Hiding Heidi (contrast)
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6
Q

Visual fields

A 
Arc perimetry 
HVF
-standard
-120 point 
-esterman binocular 
Goldman
Octopus
Microperimeter (MAIA)
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7
Q

Other essential equipment for starting up low vision

A

Trial frames
Trial lenses
JCC lenses
Tint samples

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8
Q

Near devices to demonstrate

A
  • HHM (illuminated and non illuminated)
  • stand magnifiers
  • dome magnifiers
  • microscopic/half eyes
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9
Q

Intermediate devices to demonstrate in low vision

A

Telescopes

  • max detail
  • spec mounted
  • Beechers
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10
Q

Distance devices to demonstrate

A

Telescope

  • hand held
  • spec mounted
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11
Q

Electronic devices to demonstrate in low vision

A

Portable hand held CCTV
Portable desktop CCTV
Desktop CCTV

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12
Q

Medical insurance and low vision

A 
Will cover evaluation
-includes Medicaid and Medicare 
Typically covers OT services
Does not cover devices or glasses
-exception after cataract glasses
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13
Q

Vision insurance and low vision

A

Can be used for glasses and CL
Typically does not cover devices
-exception: some VSP plans

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14
Q

Diagnosis codes and low vision

A

-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

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15
Q

Mild or no visual impairment

A

Equal to or better than 20/70

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16
Q

Moderate visual impairment

A

Worse than 20/70

Equal to or better than 20/200

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17
Q

Severe visual impairment (2)

A

Worse than 20/00 but equal to or better than 20/400

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18
Q

Blindness cat 3

A

Worse than 20/400 but equal to or better than 20/1200 (5/300)

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19
Q

Blindness cat 4

A

Worse than 20/1200 (5/30) but better than or equal to light perception

20
Q

Blindness cat 5

A

No light perception

21
Q

Blindness cat 9

A

Undetermined or unspecified

22
Q

Notes on visual impairment codes

A
  • 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
23
Q

E/M codes

A
  • traditional use
  • billing on time
  • prolonged service
24
Q

Consultation codes

A 
In patient consultations 
In office 
-certain requirements needed in chart
-documentation of correspondence 
-not applicable to Medicare
25
Q

99203

A

New
Detailed Hx
Exam: detailed, 9-13 elements
Medical decision: low

26
Q

99204

A

New
Comprehensive Hx
Exam: comprehensive-14 elements
Medical decision: moderate

27
Q

99213

A

Established
Exp problem focused Hx
Exp problem focused exam: 6-8 elements
Medical decision: low

28
Q

99214

A

Established
Detailed Hx
Detailed exam-9-13 elements
Medical decision: moderate

29
Q

How many elements are required on new patients

A

3/3

30
Q

How many elements are required on established patients

A

2/3

31
Q

New patient, comprehensive history, detailed exam, moderate decision making

A

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

32
Q

Prolonged service codes

A

99354

  • are able to be used when face to face physician time exceeds limits outlined in CPR
  • not applicable to students
33
Q

Billing on time

A

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

34
Q

Documentation for billing on time

A

Start time: X refraction stat time: X refraction end time X end time: X

35
Q

Consultation codes

A
  • 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
36
Q

Outpatient consultation codes

A

Key component for office of other outpatient consultation, all 3 are needed for selecting correct code

37
Q

Hospital in patient services-subsequent care

A
  • 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
38
Q

In patient consultation codes

A
  • these codes are for hospital inpatietns, residents of nursing facilities in a partial hospital setting
  • al three components needed for selecting correct code
39
Q

Ancillary testing

A

Not included in time

  • VF (including arc perimeter)
  • micorperietry
  • OCT
  • color vision
  • refraction
40
Q

Refraction and medical insurance

A

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
41
Q

Training codes

A

Physical medicine and rehab codes

  • 9735: self care/home managment training
  • 97530: therapeutic activities
  • 97537: community work/reintegration
42
Q

physical medicine and rehab code: 97535

A
  • 1 unit=15m increments
  • self care/home management training
  • training on use of devices, non optical aides, etc
43
Q

Physical medicine and rehab code 97530

A

1 unit=15m increments
Therapeutic activities
Train on eccentric viewing, visual field awareness/ scannning

44
Q

Physical medication and rehab code 97537

A

1 unit=15m increments

  • community/work integration training
  • shopping, transportiona, Money management, task modification, lighting, etc
45
Q

Guidelines for training codes

A
  • 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
46
Q

Materials for low vision and insurance

A 
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
47
Q

Materials assistance

A

Lions club
KYOB
Vocational rehab
Financing options

3F: Low Vision Final (8 decks)

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