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Utah Medicaid is changing their copays for 2014:

For Non-Traditional (Blue Card), they used to only cover the first $30, then you would pay the balance. Now, at my office your routine eye exam is covered without any copay since I am an optometrist. (At an ophthalmologist office, there is a $3 copay.)

For Primary Care Network, a.k.a PCN (Yellow Card), you used to have a $5 copay. For 2014, there is no copay on the routine eye exam at my office since I am an optometrist. (At an ophthalmologist office, there is a $3 copay.)

For Traditional (Purple Card), there is still no copay for 2014 on a routine eye exam.

I think it’s funny how the patient pays less to see an optometrist vs an ophthalmologist. On the face it doesn’t feel fair. Theoretically, for the same procedure code, why should the patient pay any different?

Practically, OMDs charge more than ODs, so maybe this is a way for Utah Medicaid to incentivize “clients” to see an optometrist instead of an ophthalmologist. OMDs could be miffed, but they probably aren’t because $3 isn’t that big of a penalty; therefore, it should cause very few patients to actually alter provider choice.

Still, it’s curious. I wonder at what OD/OMD copay differential the OMDs would become vocal.

Tags: Government, insurance, ophthalmologist, optometrist

I 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.

Tags: doctors, Government, insurance, Medicaid, ophthalmologist, optometrist, patients, politics

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.

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?

Tags: doctors, Government, law, OMD, ophthalmologist, optometrist, Organized Optometry, patients, politics

Every year the great folks at Mount Ogden Eye Center throw a shindig for all the optometrists within their market area. They schmooze us with a fancy, delicious lunch at Sherwood Hills Resort and then treat us to a free round of 9-hole golf (with cart).

Of course they learned us stuff during the lunch (something about multi-focal IOLs and Intralase, I recon), but with the golf, they have prizes for the longest drive on one hole and the closest to the pin on the par-3 hole.

And guess who got the prize for the closest to the pin! Yep, me. And I have three witnesses. So I got a prize for free stuff at the club house.

Of course, don’t ask me about my 3-put on that hole, and also don’t ask me about my sixty-something score for nine holes, either.

Anyway, I highly recommend that all the optometrists in northern Utah attend next year.

Tags: Golf, ophthalmologist, optometrist