Corneal Topography: How Can It Increase Profitability?
July 17, 2013
I think corneal topography is a very valuable clinical instrument that is underutilized by optometrists. If you have a topographer, read on for possible new ideas on how to get maximum utilization; if you don't have access to a corneal topographer, this article will show you how you can buy one and have it pay for itself immediately.
The usual uses
Most optometrists who have a corneal topographer use it on a variety of cases, including monitoring keratoconus, screening for LASIK candidates, diagnosing irregular astigmatism and corneal distortion and prescribing contact lenses in orthokeratology. These are all excellent uses for the instrument, but the problem is that those cases are relatively rare in most optometric practices. In most practices, this amazing instrument ends up being relegated to sitting in a room with a dust cover on it. The instrument has much more potential than that and it can produce significant practice revenue.
Don't look just to a CPT code
While most of us look to CPT codes when it comes to generating revenue with clinical instruments, corneal topography can also be used very nicely even when there is not a medical necessity and the procedure is not billed to medical insurance. CPT code 92025 can still be used when there is a medical diagnosis to go with it, but the test can also be billed to the patient as part of routine contact lens fitting or evaluation with no code at all. In my experience, Medicare and private medical insurance can be a little finicky when it comes to this code; it is not a universally covered procedure and you may meet with more rejections than other medical procedure codes.
When you require corneal topography for all contact lens evaluations every year, you will use the instrument on a very high number of patients, rather than for the relatively small group of patients with corneal abnormalities. A bonus for this higher utilization is the wow factor that your contact lens patients will experience. In my practice, every contact lens wearer has corneal topography performed every year by a technician as a pretest. The corneal map images are displayed on the computer monitor in the exam room before the doctor sees the patient. The doctor briefly reviews and discusses the maps with the patient. This elevates what would have been a routine visit with no noticeable difference from a basic eye exam, into a high-tech digital corneal examination.
Contact lens evaluation fees
There are two ways to charge for corneal topography as part of routine contact lens care. You can either bundle the procedure into your contact lens evaluation and fitting fees or you can itemize it as a separate procedure. In either case, you may want to require the test on all patients on an annual basis, not make it optional as you might for routine retinal photos or Optomap. If you elect to include the test in your contact lens evaluation fee, you should raise the fee significantly from what it is now. If you itemize the procedure, consider setting the fee at the same amount as what you would charge if it were billed medically; that way you do not have any problems with charging different fees for the same procedure. A time of service discount could be applied and remember that many vision plans require a discount on contact lens fitting services.
Your decision to itemize or bundle could depend on how most of your vision plans handle the contact lens benefit. If the plans usually provide an allowance, bundling everything into one fee may be easier and the patient pays any balance that is not covered anyway. If most vision plans have a set benefit for the contact lens fitting, you may be better off making topography a separate non-covered service. Always follow the terms of your contract with any insurance plan.
Tips on instruments
I strongly advise that you choose a corneal topographer that will be easy and fast for technicians to use. The operational differences can be significant so be sure to test the instrument yourself and consider if your average staff member could learn the technique easily. Handheld instruments tend to require more skill to operate. If topography is to be widely used in your practice, it can't be a doctor-only device. Corneal topography can be as simple as an auto-refractor, in fact there are combination instruments that do both of those tests at once.
Ask the equipment vendor about networking and if there is additional software needed for multiple viewing stations. Find out if there is an additional cost for each workstation. You want to take the measurement in a pretest room and view and manipulate the images in any exam room. Finally, find out if the instrument integrates with your EHR software.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
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