With November comes one of my favorite meetings—the American Academy of Optometry annual convention. The Academy meeting always makes me think of the great innovation taking place in our profession. New technologies will be on display, tempting clinicians with clinical and productivity advances. Yet, this cutting-edge science and innovation also brings to mind the great responsibility we all have in educating ourselves about coding, coverage and reimbursement specifics before we can implement them in our practices.

Educating ourselves about new technologies or procedures is key before spending a pretty penny to adopt them. What are the key questions and critical items you need to know prior to the purchase? After all, you don’t want to own tech that doesn’t provide a clinical benefit, especially when you haven’t planned on compliance, coverage and reimbursement details in respect to its use. Let’s lay them out:

Code It Right

Coding is the process of legally translating the service provided into an appropriate CPT, HCPCS Level II or Category 3 code. There are differences between what these codes describe and therefore their use. Make sure you know the appropriate code to use. The characteristics of that code are also paramount before employing the technology or procedure. For example, is the procedure unilateral or bilateral? Does it require physician supervision? If a surgical code, what is the global period associated with it? 

I see a lot of claims submitted to carriers with improper or inappropriate CPT codes used, which creates tremendous exposure for you and your practice.

EHRS Are Not Always Right

Update your codes in your EHR to ensure the system reflects the proper coding for the new technology or procedure. EHR companies are all different, and many may not be timely in updating the new CPT, HCPCS II, Category 3 or ICD-10 codes. However, you, the practitioner, are always responsible for using the correct ones.

Carrier Policy

Before purchasing or deploying any new technology or procedure, understand where your carriers (both medical and managed vision care) stand on coding, coverage and reimbursement. If they are covered, ask about the indications and limitations of medical necessity, frequency or utilization guidelines and, finally, contracted reimbursement amounts. 

If these procedures or technologies are not covered, i.e., designated as “investigational or experimental,” then make sure that all doctors and staff understand the requirements for providing an Advanced Beneficiary Notice (ABN) or waiver of liability form as required by the specific carrier.

Scope of Practice

Legislative victories in many states have resulted in an acceleration of an increased scope of practice. It is easy to get excited about new technology that comes with increased scope when we hear the successes of our colleagues. Since optometry is still a state-by-state legislated profession, what may be within the scope of practice of one practitioner may not be within the scope of your practice. Determine whether you can perform the new procedure or use the new tech in your practice before investing in it. The best sources of information are your state board and your state law.

Informed Consent 

If the new technology or procedure requires informed consent by state law or by carrier policy, make sure to create a specific informed consent packet to present to the patient. Have an attorney who is familiar with these laws review these forms on an annual basis to make sure each is in alignment with current legal interpretation for your given jurisdiction.

‘Do it Right,’ Not ‘Do it Over’ 

There is a lot to love about advancing technology in our profession. The COVID-19 pandemic certainly accelerated the development and deployment of great innovations to provide better patient care. Attending meetings, such as the Academy’s, provides us the forum to learn more about this cutting-edge science. Be prepared to incorporate it properly into your practice and create a process that allows you to do it with little risk and a lot of benefits.

Send your coding questions to [email protected].

Dr. Rumpakis is president and CEO of Practice Resource Management, Inc., a firm that provides consulting, appraisal and management services for health care professionals and industry partners. As a full-time consultant, he has provided services to a wide array of ophthalmic clients. Dr. Rumpakis’s full disclosure list can be found here.