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Posts Tagged ‘doctors’

UT Medicaid Doesn’t Allow Optometrists to Bill Cornea Topography

David Langford, O.D. on May 18th, 2011 under Optoblog •  1 Comment

Utah Dept. of Health logoI tried billing corneal topography (92025) to Utah Medicaid as part of managing a patient’s keratoconus, and I was shocked to have it denied. The reason?

The procedure code is inconsistent with the provider type/specialty (taxonomy).

So I called Utah Medicaid, and confirmed that 92025 is the code for corneal topography, and they confirmed that optometrists are not allowed to be paid for corneal topography because only physicians and hospitals are allowed to bill this procedure code. I pressed that optometrists manage conditions like keratoconus with corneal topography and that their policy definitely needs to be changed. The UT medicaid worker said she would bring it up at their meeting, but that meeting isn’t until next week, and she had several other issues that weren’t address at the last meeting.

So, I think she was telling me that she couldn’t guarantee that anything regarding my issue would be addressed in the near future. Even if they do discuss it sometime this month, they might not change their mind.

THIS IS COMPLETELY RIDICULOUS!!!. Hospitals? Hospitals can bill for corneal topography? How often do they do that? Can we name even one hospital that even owns a corneal topographer? The only physicians who use corneal topographers are ophthalmologists, but if I were a pediatrician they would allow me to bill for it?

Attention Utah Medicaid Taxonomy-Procedure-Provider-Type Committee: I hereby declare that you should immediately allow optometrists, provider type 31, to bill and be reimbursed for computerized cornea topography, CPT code 92025. Blue Cross allows it. I am trained to perform and analyze this test in optometry school. I need it to manage conditions like keratoconus, irregular astigmatism, pterygium, pellucid marginal degeneration, and transplanted cornea. All of these conditions I see in my practice.

Until now, I am willing to grant that the taxonomy/provider-type thing is an oversight- a snafu with the computer database. Now that this error has come to light, the only reason I can think that Utah Medicaid would continue in this erroneous policy is that the committee members making that decision are a bunch of anti-optometrist bigots. I don’t want to think that, so please reverse your policy as quickly as possible and allow optometrists to bill corneal topography.

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What Should be the Line between Optometry and Ophthalmology?

David Langford, O.D. on May 10th, 2011 under Optoblog •  Comments Off on What Should be the Line between Optometry and Ophthalmology?

Kentucky now joins Oklahoma as the only states that explicitly allow optometrists to perform laser surgery on/around the eyes and even lumps and bumps removal.  (Read the article here.  H/T to kevinmd.  Also see a news article here.)

When people ask me what’s the difference between an ophthalmologist and an optometrist, I always like to say, “Optometrists do everything an ophthalmologist does except surgeries.”  (By the way, I don’t consider foreign body removal a surgery. Chalazion removal- yes, definitely a surgery.)  Even one of the ophthalmologists in the feature story seems to agree with that statement:

“We draw the philosophical line in the sand with surgery,” says Dr. David Parke, chief executive officer of the American Academy of Ophthalmology.

Of course, proponents of the bill think that allowing ODs to perform laser surgeries is good for people because, as Governor Beshear explains:

“I signed Senate Bill 110 to give Kentuckians greater access to necessary eye care.”

Now, I would probably refute that it gives people, particularly rural people, greater access to eye care. For a doctor to buy all the necessary equipment to perform a YAG capsulotomy, he would need to invest in a pretty expensive piece of equipment. To keep up payments, he would have to do a lot of procedures. How many YAGs does a rural optometrist usually see a month? Probably not a lot. How far away is the surgeon who did the patient’s cataract surgery in the first place? Probably not that far.

subtenon injection

subtenon injection


subtenon injection materials

subtenon injection materials

Optometrists are already trained in school to do periocular injections, but can an optometrist be trained to do YAGs? Absolutely. It’s an easily learned skill that is widely studied for potential complications and side effects. This stuff is not magic- it just needs training. But it’s also a skill that, if not done regularly, can get lost. If I had a patient tomorrow that needed a subtenon’s injection, I would have to refer them out because I haven’t had to do one since leaving optometry school. No way would I feel comfortable. I also think that it’s in the patient’s best interest to have a procedure done by someone who does that particular procedure regularly.

Anyway, I kind of like my definition of optometrist. What do you all think?

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Optometry Video

David Langford, O.D. on May 12th, 2010 under Optoblog •  Comments Off on Optometry Video

Apparently there was a video contest, and Marc Schmitt at PUCO submitted a great entry. I recognized three professors in it: Dr. Hannu Laukkanen, Dr. Dennis Smith, and Dr. Lorne Yudcovitch.

H/T to Dr. Maino.

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Optoblog Poetry #004

David Langford, O.D. on March 30th, 2010 under Poetry •  Comments Off on Optoblog Poetry #004

Fly open. Zipper Broken.
Eyes elevated. Me Mortified.
Seventeen bucks at Division 1 saves the day.

True story, BTW.

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PEHP No Longer Allows Consultation Codes

David Langford, O.D. on March 6th, 2010 under Optoblog •  Comments Off on PEHP No Longer Allows Consultation Codes

I got a letter this week from PEHP, a division of Utah Retirement Systems. PEHP stands for Public Employees Health Program. They state that:

Beginning April 15, 2010, PEHP will no longer reimburse consultation codes. Providers will need to bill the appropriate Evaluation and Management code for the visit.

I’ve probably never had to bill a consultation code, but I imagine ophthalmologists won’t be too happy with this change.

I wonder how long it will be until every insurance company finds out that private pay individuals rarely get billed the higher fee consultation codes…

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E-mailing Your Doctor

David Langford, O.D. on November 6th, 2007 under Optoblog •  3 Comments

Kevin, M.D. brings up the point that most doctors don’t e-mail their patients because of privacy laws. Another doctor getting a lot of press for his new practice style, Jay Parkinson, flaunts that he can do whatever he wants since he doesn’t take insurance.

Wow, makes me want to not take any insurance; however, I DO think that we can e-mail our patients as long as HIPAA rules are maintained. It’s my understanding that as long as the data is encrypted, we can communicate confidential information with patients. On my practice website, patients can e-mail me using a form. This form can be optionally encrypted before sending if they have confidential information to share.

This is all done using my public key. Only my private key with its password can decrypt the message. I didn’t go to the HIPAA Security Company store and buy it. It’s totally free if you know how. While I believe this system complies with the intent of HIPAA regulations, I can’t e-mail back a patient if they haven’t made themselves a cryptographic key pair for e-mail. I’ll bet only a very small percentage of people in the world even have one, and I’ll bet the percentage of doctors that have encrypted e-mail is even less than the general population. But I did it. It’s do-able. Sure, I’m a computer geek, but I learned computers the same way I learned eye doctoring; study and practice.

But the obscurity/confusion of how to implement encrypted e-mail communications is not the real reason doctors don’t use it. I don’t get paid to sit around and e-mail patients. I get paid for examining patients at the office. On-line communication tools work well for Dr. Parkinson since that is his mode of practice. But my patients don’t pay me a subscription, so any e-mail that I have with them would most likely say something like, “I would recommend you come in for an appointment.”

By the way, I’ve had this encrypted form feature on my website for over 18 months, and no one has ever used it nor have they used my public key to send me an encrypted e-mail.

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Optoblog Podcast 2005-06-11

David Langford, O.D. on June 11th, 2005 under Optoblog, Podcast •  2 Comments

I probably won’t transcribe my podcasts unless they are really interesting. Since this is my first one, it’s just me talking about this site. At the end is some surprise information that you won’t want to miss. 😉
In the future, I intend these podcasts to be recorded conversations and interviews with other interesting eye care professionals and industry persons.
You can listen to it by clicking Optoblog Podcast for 2005-06-11 or you can just use your iPodder application to automatically grap this and future podcasts. Simply copy the feedburner site feed into iPodder’s subscription list.
For those of you who have no idea what a podcast is please see ipodder.com or podcastx.com

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