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caroline75771

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Are the ophthalmologist and optometrist considered the same speciality if both are memebers of the same group for defining the 3 year rule of new and established pt.?

Thanks you,
Caroline
 
Sorry for the late response. I hope it will still be helpful.

Optometry and Ophthalmology are NOT the same specialty. Never.
Whether they're in the same group or not. Even if they share the chart, even within 3 years. Not the same specialty.
 
Optometrist Billing New Patient

We have an optometrist in same practice as our ophthalmologists-

I understand the optometrist can send a patient to an ophthalmologist and the ophthalmologist can bill a new patient. However, can an ophthalmologist in same practice refer a patient to our optometrist and the optometrist can bill a new patient also? Different Taxonomies.

So the Rule I have is:

OD to OD 3 year rule applies

OD to MD 3 year rule does not apply- MD can bill New Patient

? MD to OD what rule applies?

Thank you for your responses.
 
They have to be of the exact same specialty and subspecialty for the 3 year rule to apply.

Therefore, an OD to OMD referral is new to each provider if pt hadn't been seen in practice by OD before.

OMD to OD is new to both if above applies.

General OMD to retinal specialist in same practice would be new for both (different subspecialties)

general OD to low vision OD in same practice could also be new to both due to subspecialties being different.
 
Aloha! Recently my dr has been billing for extended ophthalmoscopy. Is this still a payable code? Appreciate your feedback!
 
If your doctor is using the new codes for this procedure and meeting the recording criteria with I&R, yes. That being said, the question I have is what do they consider extended ophthalmoscopy? Is it because they take some extra time doing ophthalmoscopy and figure that's "extended? If so, it isn't. Is it done because the patient has a significant retinal problem and they need to do a more in depth level of ophthalmoscopy, along with the drawing and I&R, then perhaps so.

That being said, I have seen retinal specialists do ophthalmoscopy for flashes and floaters with scleral depression and they don't bill for it.

Billing for EO too frequently can often set off a request for a records audit because many eye docs feel that if they take a few extra seconds examining the retina that it qualifies for EO when it really doesn't.

Personally, I wouldn't bill for EO unless the patient had severe diabetic retinopathy or a retinal detachment. However, in reality a good OCT ore retinal photo of the problem is going to provide you with much more usable info than EO and they reimburse at a higher level.

Tom Cheezum, OD, CPC, COPC
 
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