Insights From Our Editors

Practice-Building Opportunity: Cataract Co-Management

May 13, 2015

Cataract co-management should be an important part of your practice, statistics from the National Eye Institute suggest. By age 80, more than half of all Americans either have a cataract, or have had cataract surgery, according to the NEI.

As the Baby Boomers age, cataract post-surgical co-management will become more and more frequent in the eyecare practice. To stay out of trouble, follow these eight rules when providing cataract post-surgical co-management.

1) All co-management decisions should be based on the patient’s best interest, and not on coercion or inducements.

2) The patient should consent to cataract post-surgical co-management care in writing.

3) The surgeon and the optometrist should co-manage all patients on a case-by-case basis, and not indiscriminately, as a matter of policy.

4) The optometrist must keep complete documentation, and share records with the surgeon (i.e.: co-management is co-management).

5) Don’t bill until you see the patient and after the surgeon’s office has billed the third party for the cataract surgery.

6) Use the date for coverage agreed on by the surgeon.

7) Use the same CPT code used by the surgeon with the appropriate modifier (the surgeon submits with the 54 modifier and the optometrist uses the 55 modifier).

8) Make sure there is no payment from each other for the referral in either direction. The only payment allowed is from the third party or from the patient for co-pays and deductibles.

Your action plan for this week is to review your cataract co-management protocols making sure they follow the eight rules listed above. The best way to stay out of trouble is to not get in trouble in the first place. Follow these eight rules and you will stay out of trouble.

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