[optimal] Re: ptosis/dermatochalasis fields & external photos

From: CPMC Ophthalmic Diagnostic Center <cpmceyelab@xxxxxxxxxxxxxxxx>
To: "'Barnett, Cullen'" <Cullen.Barnett@xxxxxxxxxxx>
Date: Mon, 25 Aug 2014 15:59:40 -0700
PTOSIS

What I know: It was my understanding (pre-SOCAL) that the fields & photos 
minimum requirements are dictated/governed by the insurance company's 
guidelines/minimum requirements. Insurances vary a bit, but the basic formula 
works for all.  Furthermore, that if we (photographer) does not follow the 
minimum requirements, the claim would be denied as "medically necessary" then 
becoming an out of pocket cost to the patient as a "cosmetic" surgery. More 
based on the functionality ( the perimetry) than the photo ( cosmetic ) Is the 
lid impeding the vision and to what degree?

In my experience, this meant specifics about what was plotted and stimulus 
size, as well as this meant taking very specific instructions for the external 
photographs.  Yes, although more and more an iPhone or smart phone photo is 
done and is sufficient for insurance needs.

What goes on in our department: For the fields there is no standardized 
stimulus size, I've seen folks plot out entire/complete isopters (why you would 
need to know what's going in the inferior hemisphere for a 
ptosis/dermatochalasis patient is beyond me). I've been doing Goldmann ptosis 
fields since, sorry, before you were born.  I'm old.   It's pretty simply.   
Basically a 4V target and a minimal target ( depending on patient's VA ) of 4-1 
suffices.  Taped and untapped.  You are simply documenting the difference 
between the two.  This is not a threshold test.  Multiple isopters are 
redundant here.

As for the photos I've seen too many variations in terms of what a doctor 
captures if they take the photos or if someone other than a member of my 
diagnostics team takes the photos. Beyond that we take the photos in any room 
that we can, we don't have standardized location/background or any of that. 
When I first started (2011) here at USC, I shared my concerns with our 
Oculoplastics physicians and billing team. No one knew what I was talking 
about. I was shocked but thought heck, if this is what the prestigious Doheny 
Eye Institute was doing all these years well then, there must not be a problem 
right!? Insurance companies are not as discrimentating as we ophthalmic imagers 
are.   A very well known, high volume plastic surgery ophthalmologist here, a 
professor at UCSF, does iPhone photos all of the time without issue.  I haven't 
had a request for external photography for lid ptosis since Carter was 
president...

Where I am now: All of our oculoplastics doctors left to join the Dohney UCLA 
endeavor. I have a new oculoplastics doctor who came from a place that had 
standards in place. She has concerns stemming from a recent RAC audit which 
shows a 69% denial rate secondary to missing or incomplete documentation as it 
pertains to oculuplastics fields and photos. My guess is that the chart 
documentation andor/ the perimetry is what is lacking

In the past I had a team of folks whom I could count on as a resource to answer 
such questions. Unfortunately where I am now, we lack that sort of 
organization. I'm gonna have to figure this out on my own.

What I need:  I need to get my hands on the aforementioned guidelines & minimum 
requirements. What do you all do?   I can provide you with the guidelines.
Denice


Thanks,
_______________________________________________________________________________
Cullen Barnett, COT CRA OCT-C CDOS
Clinic Supervisor, Diagnostic Services
Department of Ophthalmology

Keck Medical Center of USC
University of Southern California
1450 San Pablo Street
Los Angeles, California 90033
Office 323-865-6814  Fax 323-865-9248
cullen.barnett@xxxxxxxxxxx<mailto:cullen.barnett@xxxxxxxxxxx>

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[optimal] Re: ptosis/dermatochalasis fields & external photos

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