Practical Pearls

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

To determine the astigmatic effect of the phaco incision, examine the last 10-20 patients on whom you have performed cataract surgery and look at keratometry measurements before and after the procedure………Find it!

Corneal higher-order aberrations can degrade visual performance in patients with multifocal IOLs. Prescreen patients with wavefront aberrometry before considering multifocals………Find it!

Medicare states that all services must be medically necessary and medically justifiable. It is not a matter of what a physician deems is "good medicine." Rather, the service must be warranted in Medicare's opinion………Find it!

Femtosecond lasers in cataract surgery allow surgeons to create a very precise capsulorhexis, which is helpful in securing the desired effective lens position; failing to achieve this is a significant source of IOL power error………Find it!

A thorough preoperative evaluation is at the top of the list for improving outcomes for premium IOLs. One surgeon advises screening cataract patients the way LASIK patients are screened………Find it!

The reasons for most Medicare audits should not be dismissed lightly. Improper chart documentation, in its various forms, and lack of medical necessity account for a huge amount of erroneous payments………Find it!

Rotationally-stable toric IOLs, such as the Alcon AcrySof Toric, have markedly increased adoption of this product category………Find it!

Prepayment audits are performed before payment for a service is issued. If appropriate documentation is found lacking in any way, a more extensive audit usually ensues………Find it!

A study of patient satisfaction with Crystalens HD and ReStor D1 found that while both groups had high satisfaction scores, the percentage of patients whose expectations were not met was also high in both groups. The investigator believes that better patient education is required to improve expectations scores………Find it!

Recent changes to Medicare reimbursement rates will deliver about $550 million per year in new revenue to ophthalmology as a whole, including an average 17% increase for cataract surgery fees………Find it!

When considering which IOL to implant in a patient with prior refractive surgery, note that a study found multifocal IOLs should only be used when the original correction was low myopia. Toric IOLs should be used cautiously, with selection based on topographic cylinder………Find it!

For cataract patients with preexisting or coexisting conditions such as CME, glaucoma or uveitis, acrylic IOLs may be preferred over silicone lenses because of concerns over the potential need for future retinal surgical intervention………Find it!

The true indicator of a successful EMR implementation is the lack of support services required after an installation………Find it!

A study of presbyopia-correcting IOLs and image quality found that the performance of multifocal lenses is very dependent on pupil size………Find it!

Optic nerve progression done via registration-guided overlay of serial images makes differences impossible to miss………Find it!

Refinement of IOL biomaterials and surgical instrumentation have allowed smaller incision sizes and thus has created a change in mindset that has allowed surgeons to no longer accept the status quo of simple pseudophakia………Find it!

When coding for a new patient visit, the adjective used to describe complexity determines the E/M level: "low" = level 3, "moderate" = level 4, and "high" = level 5………Find it!

Cataract patients resent the added paperwork of a questionnaire, so devote more chair time to the discussion of premium IOL suitability………Find it!

Toric multifocals and next-generation accommodative lenses are high on the list of advances in IOL technology that surgeons would like to see in the near future………Find it!

Hyperopes and high myopes do well with "just about any" IOL, but low myopes often don't see a benefit to presbyopia-correcting lenses and may be better suited to monovision………Find it!

RAC audits are those performed by an outsourced contractor whose payment is on a contingency basis. The issues that they are auditing must be approved by CMS and are posted on the various contractors Web sites………Find it!

The forthcoming Synchrony accommodative IOL takes about three months to settle into place because there is some constriction of the capsular bag that goes on during this period………Find it!

If you search CPT for the term "wavefront aberrometry," you will not find it, but by understanding the test and how it works, you can avoid selecting a miscellaneous procedure code that usually results in billing headaches………Find it!

In four years' time, ophthalmology reimbursement rates for Medicare patients are likely to be vulnerable to fee cuts………Find it!

EMR vendors stress that the practice owns its own patient data but the vendor is available as a resource to help improve security………Find it!

Use code 92014 for comprehensive eye exams but not for follow-up visits for serious disease. For the latter, use 99214 as long as your medical decision-making is moderate and you have the medical necessity to perform nine of the required elements………Find it!

Diversion of payments to a "dummy" account with the explanation of benefits and payment details diverted to a separate PO box can easily be accomplished when only one person is in charge of posting payments and managed-care contracting. Separation of duties among staff, with checks and balances, can help prevent this form of embezzlement………Find it!

Medicare doesn't cover refractions for any reason, so it stands to reason that they will not cover wavefront aberrometry either………Find it!

In implementing your EMR system, getting your staff trained on both basic computer skills and your new EMR system will take time. Don't let it disrupt your practice. Allow time either during the day when the clinic is light or after hours. And don't forget to test those skills prior to your golive day………Find it!

Minimal services, such as quick check-ups for conjunctivitis or healing of corneal abrasions, should be coded 99212 — not with 99213 or 92012………Find it!

Comparative effectiveness of medical interventions are of increasing interest to policy-makers and, by extension, to payers of health care, who'll use them in coverage decisions………Find it!