Practical Pearls

A Handy Guide to the Best Take-Home Tips in the January 2009 Issue of Ophthalmology MANAGEMENT

For a prescription to count toward Medicare's new E-Prescribing bonus, one of the following G-codes must be added to the claim: G8443, G8445 or G8446……Find it!

A small optic disc in an apparently healthy eye with an average number of nerve fibers will appear crowded (i.e., small to non-existent cup). If this type of eye has glaucoma, considerable rim loss may occur before the loss is apparent by examination……Find it!

If postoperative hyperopic shift occurs in a Crystalens patient, the anterior chamber can be deflated via a paracentesis, causing the IOL to shift anteriorly and inducing approximately 1 to 1.5 D of instant myopia……Find it!

Compliance can suffer when a patient's finances are stretched to the limit. Glaucoma medications "are often the first to go" because there are rarely any acute changes when patients miss doses……Find it!

An employee manual creates transparency and helps eliminate favoritism, as all employees are held to the same rules. It is important not to deviate from the manual, as this undermines its importance and reduces its legal support of the practice……Find it!

The Haigis formula for IOL calculation is not as widely used and is more complex than 2-variable formulae but may be more accurate in post-refractive surgery eyes……Find it!

When considering a LASIK enhancement, OCT imaging can help determine if there's enough residual stromal tissue……Find it!

Most practices tend to undercode because they either fear being audited or lack expertise in coding. A good coding consultant can help a practice optimize reimbursement while also staying in compliance with the law……Find it!

Whether using Snellen, Lea or Allen optotypes in amblyopia diagnosis, use either an entire line of type, or crowding bars around a single optotype. Single, isolated optotypes provide a false over-estimation of the acuity and result in false-negative findings of "normal."……Find it!

The new Category III CPT code 0187T is to be used for anterior segment OCT imaging. Code 92135 has been revised to specify posterior segment use……Find it!

When looking for new revenue sources, consider offering audiology service, as it is primarily directed toward many of the same seniors who require regular visits for eye care and who trust in their ophthalmologist……Find it!

Collection ratios measure practice efficiency in obtaining payments. Gross collection ratio is total charges divided by total collections for that charge. Net collection ratios are total charges less their contractual adjustments divided by total collections for those charges……Find it!

In a comparison of Epi-LASIK and off-flap Epi-LASIK, no significant difference in uncorrected visual acuity was found during the early postoperative days, but UCVA was significantly better in Epi-LASIK eyes at 6 months……Find it!

The patient may have little else by which to judge a surgeon other than his or her presentation and the condition of the office. Many will conclude that a physician working in a messy or dirty exam room practices similarly careless medicine……Find it!

A survey found that 90% of ophthalmologists screen for hydoxychloroquine retinopathy correctly (either central automated threshold perimetry or Amsler grid) but knowledge of evidence-based risk factors (daily dose, duration of therapy and patient age) was "poor"……Find it!

If a visual field is abnormal but the optic disc and retinal nerve fiber layer appear normal by exam, the first step is to repeat the visual field. The OHTS showed that 86% of field defects reverted to normal on repeat testing……Find it!

The premium IOL channel is vital to the longterm future of cataract/refractive surgeons and their patients. Don't sugarcoat expectations or offer discount pricing to achieve short-term volume gains for economic reasons……Find it!

Comparing patient visits last month with that number in the previous month, the same month of the prior year, year to date this year, and year to date for the prior year may help you predict and manage future patient flow……Find it!

Anterior segment OCT can prove valuable in corneal ulcer patients when opacity prevents proper visualization of the anterior chamber structures with the slit lamp, because the energy used in OCT imaging penetrates better than visible light……Find it!

When performing cataract surgery in a prior RK patient, the high pressure used during the procedure can cause the RK incisions to rupture and leak. For this reason, all incisions should be carefully checked by using a fluorescein dye leakage test at the end of the surgery……Find it!

If structural tests in a glaucoma patient show an abnormal result but the visual field is normal, consider performing a selective functional test with SWAP or FDT, both of which isolate a subset of ganglion cells. Studies show that they can be predictive of future functional loss……Find it!

Having a simulated day of clinic before going live with EMR will uncover workflow problems that weren't evident in the planning process. The workflow with EMR will be different in unexpected ways, and simulation day is the day to learn that — not your go-live day……Find it!

Artifical tears that contain the osmotic agent glycerin can reduce or eliminate the blurriness upon instillation that is typical of other tear supplements……Find it!

Ophthalmologists interested in adding a surgery center but leery of making the financial commitment alone can join together to share a facility, with the day-to-day servicing of the ASC outsourced to a national firm that provides all of the equipment and supplies, plus a tech who assists in surgery, for a fixed fee per case……Find it!

When selecting a cycloplegic agent to treat acute anterior uveitis, atropine is useful in some situations but is less preferred due to its long duration of about 2 weeks……Find it!

Many practices don't recognize that they are borrowing from the retirement plan when they accrue the plan contribution each year, creating a significant short-term liability……Find it!