Dilation in a separate visit?

[VA Hopeful Dr]

I've got a quick question, if anyone has any insight.

An OD office just opened with a brand new doctor. The office has, to my mind, an odd way of doing exams. A comprehensive exam would take place on 2 different days. On the 1st day: refraction, NCT, lids, muscle balance, and conjunctiva; on the 2nd day: dilation. Basically, the patients have to come back on a different day for the dilation part of their exams. Why would the exam be done this way?

Any thoughts?

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[Richard_Hom]

I've got a quick question, if anyone has any insight.

An OD office just opened with a brand new doctor. The office has, to my mind, an odd way of doing exams. A comprehensive exam would take place on 2 different days. On the 1st day: refraction, NCT, lids, muscle balance, and conjunctiva; on the 2nd day: dilation. Basically, the patients have to come back on a different day for the dilation part of their exams. Why would the exam be done this way?

Any thoughts?

Dear VA hopeful Dr,

1. Dispensing glasses and contacts are easier if the patient is not dilated
2. Patient may not have been prepared for the post dilation visual disturbance
3. Coding considerations.

Richard Hom OD FAAO

 

[rpames]

I guess it could decrease chair time b/c the patient would not be sitting in the office while they dilate. Then when they come back you could just do a quick DFE.

Personally I think it is not a good idea. What patient would come back to the office a second time. At the school it is hard enough to get the patient to stay though the whole exam, much less get them come back.

As Dr. Hom mentioned, there are reasons to do such a thing, but doing it on every patient doesn't make sense to me.

 

[cpw]

not on every patient, but on patients who are new to contact lenses and have to go through an I&R I dilate them on their contact lens check visit the following week.

But, anyone I've never seen before gets those drops 🙂

 

[VA Hopeful Dr]

I appreciate all the prompt responses on my question.

Dr. Hom, your answer ran parallel to my possible concerns. I could not think of one reasonable clinical rationale for doing this to every patient (outside the glasses/contacts issue), so I started to think towards insurance/billing.
What kind of coding considerations are there that would make this practice worthwhile?

 

[Richard_Hom]

I appreciate all the prompt responses on my question.

Dr. Hom, your answer ran parallel to my possible concerns. I could not think of one reasonable clinical rationale for doing this to every patient (outside the glasses/contacts issue), so I started to think towards insurance/billing.
What kind of coding considerations are there that would make this practice worthwhile?

Dear Va Hopeful Dr,

There are certain billable procedures which if unbundled from the comprehensive eye examination (92004) if they are done on a second visit. Suffice to say that this exists. I dont' believe going into more depth would necessarily answer this question any better.

Richard Hom, OD FAAO

 

[Richard_Hom]

I appreciate all the prompt responses on my question.

Dr. Hom, your answer ran parallel to my possible concerns. I could not think of one reasonable clinical rationale for doing this to every patient (outside the glasses/contacts issue), so I started to think towards insurance/billing.
What kind of coding considerations are there that would make this practice worthwhile?

Dear Va Hopeful Dr,

There are certain billable procedures which if unbundled from the comprehensive eye examination (92004) if they are done on a second visit. Suffice to say that this exists. I dont' believe going into more depth would necessarily answer this question any better.

Richard Hom, OD FAAO