Practical Pearls

A Handy Guide to the Best Take-Home Tips in the March 2010 Issue of

Pretreating LASIK patients with hyperosmotics significantly reduces epithelial disturbances in patients over age 35…………………………Find it!

For an encounter to qualify as E/M level 4, you must have an extended history of the present illness: four or more elements must be qualitatively described. If you only describe three elements, the entire encounter drops to a level 2…………………………Find it!

Retisert reduced the percent of uveitis patients requiring systemic steroids from the 47% to 63% range down to the 5% to 10% range…………………………Find it!

Payers tend to automatically categorize eyelid and brow surgery as cosmetic. If reimbursement is expected, it's essential that the chart documentation contain information to support a medically necessary procedure…………………………Find it!

Night-vision problems have become less frequent in LASIK patients, but do still occur. One surgeon recommends Alphagan to reduce symptoms without resorting to further surgery…………………………Find it!

Consider implanting intracanalicular plugs in all refractive surgery patients to prevent postop dry eye. Unlike punctal plugs, they will not rub against the eye and don't require removal…………………………Find it!

Femtosecond laser capsulotomy is accurate within 0.1 mm of the intended position and diameter, and has been found strong under tensile strength testing and SEM analysis…………………………Find it!

Most ophthalmologists believe the eye codes are easier to use and more audit-proof than E/M. Not necessarily so! If you use only eye codes, you are punishing yourself financially and may be found to be upcoding or downcoding in an audit Find it!

Sustained-release drug systems could potentially come in the form of implants, inserts, gels, microspheres, polymers, sealants or even incorporated into an existing visual system such as a contact lens or IOL…………………………Find it!

Contrary to popular belief, younger refractive surgery patients required fewer enhancement procedures for residual refractive error than older ones in a review of over 5,000 cases…………………………Find it!

Ocular allergy drug Bepreve reduced total non-ocular allergy symptoms by 77% within seven minutes after dosing…………………………Find it!

Laser technology could give cataract surgeons the ability to create a perfectly sized and centered capsulorhexis with reduced risk of radial tears and rupture of the posterior capsule…………………………Find it!

When determining the medical decision-making component of E/M coding, the two tasks that seem the most troublesome for ophthalmologists are defining chronic illnesses and deciding the level of surgery…………………………Find it!

The MRD1 is the distance from the upper lid margin to the first Purkinje image, or the reflected image from the anterior corneal surface of a light held in front of the patient. It is a true measurement of the amount of ptosis present, independent of the amount of redundant skin…………………………Find it!

Consider giving LASIK patients a 10-question true/false “pop quiz” on the day of surgery to make sure they have an accurate understanding of the procedure and its risks. More than two wrong answers means further patient education is necessary…………………………Find it!

If a practice chooses to go with a fully customizable EMR system, there is greater flexibility but considerable increased risks and delays in implementation…………………………Find it!

Your personnel handbook should prohibit staff from accepting gifts from vendors. It is quite common, and also legal, for frame and lens vendors to “incentivize” your employees, especially your optical manager and opticians…………………………Find it!

Ozurdex is biodegradable and the procedure can be done in the office. Its side effect profile is also well tolerated. IOP elevation peaks around day 60 but returns to baseline by month six…………………………Find it!

When shopping for an EMR system, visit a few ophthalmology practices that currently use the top systems on your short list…………………………Find it!

People who have had vision loss since childhood report better quality-of-life and adaptation than those with more recent vision loss…………………………Find it!

Market dynamics have developed that are making it more cost effective, more convenient and potentially even safer to have refractive surgery rather than wearing extended-wear contact lenses. Those factors could have significant effect over the next 10 years…………………………Find it!

It is critical to gauge the personalities and technical abilities of your staff prior to starting EMR implementation to ensure that the solution type chosen matches the practice, and the staff, that will be using it…………………………Find it!

Four factors that will influence the integration of femtosecond lasers into cataract procedures are: the number of ORs at your facility, the number of laser systems available, the number of surgeons operating at the same time, and the number of ORs used by a given surgeon…………………………Find it!

Most ophthalmologists are unaware that the ethical medical business practices that they were taught to abide by are not the norm in the retail world of optical…………………………Find it!

Femtosecond-created LASIK flaps with steep side-angle architecture, akin to a manhole cover, are superior to beveled side-cuts done with mechanical microkeratomes. The latter allow flap slippage and minor trauma…………………………Find it!

When assessing risk level for the purposes of E/M coding, do not to be confused by the fact that there are risks inherent in all surgery. Consider the likelihood or probability that complications or unfavorable outcomes would occur with that given surgery in that given patient…………………………Find it!

A drug-coated punctal plug for glaucoma patients that can remain in the eye for 90 days would be a huge help in achieving compliance and produce a major shift in the way glaucoma can be treated in the future…………………………Find it!

Having well-defined goals for an EMR system can help you avoid unrealistic expectations, inadequate customization, loss of productivity, and ultimate abandonment of the system…………………………Find it!