By Jeanmarie Davis, OD
For low upfront costs, you can add comprehensive macular degeneration care to your practice services and tap an immediate revenue stream
There is anoften-overlookedopportunity in managing macular degeneration patients. Theirs is a treatable condition, not a curable one, so long-term treatment is built in. These patients require close follow up and are typically very loyal and compliant as they seem to understand the serious nature of this disease and the risk that accompanies this condition. They will also refer their family members to your practice since they are aware of a possible hereditary component.
High Volume Dependent on Practice Demographics
The number of macular degeneration patients depends on the demographics of the practice. An older Caucasian population will have a higher percentage of macular degeneration. When I worked in a practice in south Florida with that demographic, I would typically see about four to five macular degeneration patients a week. Regardless of the number of patients you have with macular degeneration, it is an opportunity to build a personal relationship with those patients and their families. You can raise your credibility by being knowledgeable about such a serious eye condition, and that brings referrals. Even patients without macular degeneration will have a great degree of trust that you will be able to detect a serious problem since you are experienced in caring for macular degeneration patients.
Number of Follow-Up Visits Depends on Disease Stage
The number of visits-per-year depends on the stage of the disease. A patient with very early macular degeneration may only need to be seen twice a year. However, you can bill at a higher level and perform other testing for which you will be reimbursed. Retinal photography and OCT are examples of additional testing that may be necessary for these patients. In the more advanced stages, or the wet form of the disease, there are more office visits involved and potentially co-management with a retinal specialist. The codes used are the same codes for the appropriate level of the office visit and the actual testing or procedure you perform.
Consider Offering Low Vision Aids
In cases where the disease is in the more advanced stages, and has resulted in significant visual loss, there is an additional opportunity for low vision exams and selling low vision devices. There is a great opportunity here since most ODs and retina specialists do not offer this type of service. However, it does take commitment and patience to offer low vision aids. It is a highly specialized service and takes more time than a typical exam.
Billing and Coding for Macular Degeneration
Regular office visit codes for the appropriate level are used as well as special testing codes. The use of special testing codes may trigger an audit so it is very important to be familiar with local rules and guidelines and to document extensively in your medical records. However, done appropriately, using the following codes can bring a boost to your practice.
92134 Scanning computerized ophthalmic diagnostic imaging of the retina with interpretation and report, unilateral or bilateral. This is a fairly new code billed once whether you scan one eye or both.
2019F dilated macular exam
4177F AMD counseling with AREDS supplements
92250 Retinal photos. Frequency is determined by what is medically necessary. This usually will be covered as a baseline and to monitor change but not simply to document the existence of the condition. Practitioners should check with the carrier guidelines as to how this is covered.
92082 this is the code for visual field that may be used for preferential hyperacuity perimetry with the Foresee PHP. This may or may not be covered.
Invest in Necessary Instrumentation
Typical instrumentation found in any optometric practice such as a slit lamp and binocular indirect ophthalmoscope with retinal lenses are used. Additional macular lenses are highly recommended. These are not expensive, typically running a couple hundred dollars. Depending on the volume of patients you have, it may be advantageous to invest in retinal photography and a retinal scanning laser. This type of instrumentation is quite costly–in the thousands to tens of thousands of dollars–but can be leased, as well. There are other alternatives to investing in your own instrumentation. There are companies that will bring the diagnostic instrumentation to your office for a few hours or a full day. They charge a fee, so you would schedule numerous patients to come in on the same day. Depending on your needs, this can be done once a week or once a month, etc. Although not as convenient, you also can refer macular degeneration patients to a local OD who does have this instrumentation and have them perform the technical portion and get the patient back to you. This will require a good relationship with that practitioner and their office staff.
No Certification Required
There is no additional certification needed, however, a thorough knowledge and comfort level with the disease process, risk factors and currently available treatments and anticipated outcomes are required to manage these patients. A good working/co-management relationship with a retinal specialist who treats macular degeneration is also necessary. The patient will ultimately rely on you, the primary OD, for appropriate referral and a thorough explanation of their options and expectations when being referred to the retinal specialist. You should understand the retinal specialist’s preferred method of treatment and general protocol and have regular and open communication with the specialist. Often the patient will return to the referring OD asking for an explanation of what happened in the retina specialist’s office. These patients are usually well aware of the serious nature of this disease and are afraid of going blind. You must be well informed and able to educate them.
Macular Degeneration:Keys to Treatment Success
Understand the emotional state of these patients and treat them with great care. They are typically afraid of losing their vision and need to have a high level of confidence and trust in you. Take extra time to speak to them and educate them about the disease and the stage if their condition. I tell them: “We cannot cure macular degeneration, but we have good success in managing it, so we are able to slow the progression of the disease in most cases.”
Patients must be educated and instructed on daily monitoring using a home ambler grid. They must understand it is critical that they check carefully every day and need to see you urgently if they notice any changes. I tell them: “Now you have a key role to play in your success.”
Make certain to address lifestyle choices that may affect their condition. Educate smokers on the importance of quitting smoking. Treat those cases with supplements when appropriate. I tell them: “You can help yourself by choosing a healthy lifestyle. Quitting smoking will help slow the progress of macular degeneration, keeping your eyes in better shape so you can more fully enjoy life.”
Related ROB Articles
Make Your Practice Eyecare Emergency-Ready
Manage Glaucoma Patients to Increase Medical Eyecare Reimbursement
Enhance Dry Eye Treatment to Better Serve Patients
Jeanmarie Davis, OD, recently joined Alcon’s Global Performance Development department as manager, technical, Global Performance Development. To contact her: drdavis2020@yahoo.com.
