educational question

Discussion in 'Optometry' started by thiaeyemd, 10.01.14.

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  1. thiaeyemd

    thiaeyemd New Member 10+ Year Member

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    I have a question so i can be educated by the ODs here. When you see a patient with eye insurance (VSP or whatever) is a dilated exam part of it or is it just a refraction? What about a patient with no insurance who just wants a pair of glasses? Is the DFE an extra charge or routine? What about eye pressure? I apologize if this is a stupid question but I only do plastics and neuro and a friend was asking and I thought this would be a good place to ask

    Thanks
     
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  3. 310

    310 2+ Year Member

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    1. A dilation is not a required part of a vsp exam. Certain doctors will do a "routine" dilation for free as part of the exam. Others will have an out of pocket cash fee. Other doctors will only do it if filed under medical insurance and with appropriate coding. Others (cringe) don't do it at all under any circumstances.

    2. With cash patients it varies by location. The dilation usually will cost more.

    3. Eye pressures should always be checked as part of the exam and at no cost. Some doctors will let kids and young people slide through without proper pressure checks. A very small percentage of doctors who are extra negligent let lots of people go without checking the pressure.


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  4. KHE

    KHE Senior Member SDN Advisor 10+ Year Member

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    I don't really agree with the other responder on some of his statements.

    My experience is that every optometrist checks pressures when appropriate and certainly on all routine exams. Maybe there's about twelve 85 year olds left who don't 99.99% of ODs so this as appropriate.

    Regarding dilation, my experience with that is that only commercial practices charge extra or give the routine patients the option. Every private OD in the the three states I've worked in have included DFE as part of the comprehensive evaluation fee and performs it as indicated.
     
  5. Commando303

    Commando303 7+ Year Member

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    It's not at all a stupid question, and in fact it's one of the contentious topics of optometry practice. As in many health-care fields, much of the examination (unfortunately) is determined by insurance panels rather than by clinical judgement. In general, dilation does not appear to be mandated by most insurance companies, however varying requirements to evaluate the ocular fundus might be, and this may (or mayn't) necessitate dilation.

    In addition to insurance, however, is "standard of care," and dilation appears to have become established as part of the standard of routine/comprehensive eye-care.

    Regarding extra charge, I know some optometrists do this, but it's possible one's ability to do so will vary by one's practice location (i.e., by one's state board of optometry).

    Now, if payment is by cash, you can do whatever the hell you want (provided it's not medically, legally, or medico-legally problematic).
     
  6. PBEA

    PBEA Senior Member 10+ Year Member

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    if its a "routine" DFE, as in no complaints, or relevent history, etc then yes I will often perform DFE as part of the routine exam. For me that is generally all new pts, and at some interval for established ones. If however the pt has a medical complaint (floaters, pain, etc) or has relevant medical history (diabetes, HTN, etc) then no it is not a "routine" DFE (or exam) and I would bill the entire encounter to the medical plan. DFE in and of itself should not be an extra charge but if a drawing is required for a specific and pertinent finding then extended ophthalmoscopy is billed. Like KHE mentioned most mall places do charge extra for "routine DFE" which is asinine, but it's the mall, and they don't do anything correctly IMO. IOP's always included and pretty much always done.

    If a pt "just wants glasses" and doesn't have insurance then they don't really need an exam now do they. They can just purchase glasses. That's a bit obtuse so I apologize but if they do request an exam then the usual protocols apply regarding medical exam vs routine vision exam, and the need (or lack thereof) for dilation. Just "wanting new glasses" shouldn't change any of that paradigm.
     
  7. Meibomian SxN

    Meibomian SxN 7+ Year Member

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    Most vision plans stipulate that DFE is included in the exam, free of charge. I have yet to see any vision or medical insurance that says it is not covered.
    Also if a patient were to ever sue the OD for anything, the lawyer will easily show that the AAO and AOA both agree that dilation is a part of the annual eye exam.
     
  8. 310

    310 2+ Year Member

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    There are several reasons why this can't be easily proven, but that's a long winded argument with several directions that I won't get into.


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  9. Meibomian SxN

    Meibomian SxN 7+ Year Member

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    Its easily proven because any doctor the prosecutor uses will testify that all new patients should be dilated as part of an annual exam. I'm not saying the you would be found guilty but leaving out a DFE makes you look like a "negligent doctor" which makes a medical malpractice case easier to go to trial.
    Its always best to document "Patient refused DFE today" or "Patient to return to office for DFE as scheduled".
    I've been to a deposition before for another doctor so I can tell you that yes, the lawyers really hone in on DFEs.
     
  10. 310

    310 2+ Year Member

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    Yes, it needs to be documented why the dfe wasn't performed. However, the vast majority of people in need of a dfe can be screened out during an undilated exam. This profession entails some liability which, of course, will be higher if too many dilations are skipped assuming you aren't closing angles.


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