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    Consider nursing home optometry as practice option

    Increasing elderly population and disease incidence means more need for care


    Exam protocol

    The exam protocol is conducted in two phases to maximize the number of patients who can be seen in a timely manner.

    The initial phase includes case history and chart review, preliminary testing and acuities, anterior segment evaluation, intraocular pressure (IOP) measurement, and dilation.

    The second phase is completed once the eyes are dilated. It consists of posterior segment evaluation with fundus lens, dilated retinoscopy, trial frame refraction, and frame evaluation (if needed).

    As with all modes of practice, it is very important to document, document, document per Medicare billing and coding guidelines.

    At the conclusion of the exam, it is important to compare the exam findings to the minimum data set (MDS) 3.0 intake and make changes if necessary.

    The MDS 3.0 is a tool for implementing standardized assessment and for facilitating care for a new resident upon entry into a facility. Its purpose is to improve quality and care in the nursing home setting and is beneficial for residents, families, providers, and policy makers.8

    The vision findings of this assessment can be found in Section B (B1000 and B1200). If vision function is worse than what is recorded, inform the social worker and director of nursing.

    Related: 4 steps to opening a practice cold

    Be prepared to write orders for medications, treatment plans, or referrals that are needed at the conclusion of the exam. Remember to document and have a plan to schedule follow-up exams as needed.

    Finally, it is a good practice to have that day’s patient list with diagnosis and follow-up plan signed by the social worker before exiting the facility to prove the services were performed and verified in case of a later audit.

    Billing and coding

    Billing and coding in the nursing home is different than in office settings.

    CPT codes 992XX used for medical diagnoses cannot be billed for services rendered in the nursing home. Ophthalmic codes 92XXX are acceptable and typically used for initial and follow-up exams. Secondary CPT codes 99308, 99309, and 99310 can be used as well.

    Be sure to consult your CPT coding authority and Medicare healthcare administrator for specific coding and billing guidelines appropriate for billing nursing home care.

    James Hill, OD, FAAO
    Dr. Hill provides nursing home care to multiple facilities in his area and holds a specialty low vision clinic at the Medical University ...


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