Cataract & Implant Co-Management

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California optometric laser associates

Cataract & Implant Co-Management

policy and procedure manual

California Optometric Laser Associates

Co-Management of Cataract and Implant Patients Policy and Procedure Manual

Table of Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Step-by-Step Process for Cataract Surgery Co-Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Treatment Protocols: What to Look for Pre and Post-Operatively . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Cataract Co-Management Billing for Medicare Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Sample Medicare Billing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Supplemental: Clinical Forms Cataract Co-Management Treatment Plan (Patient Handout) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Cataract/Implant Co-Management Pre-Op Exam and Consult Request Form . . . . . . . . . . . . . 13 Co-Management Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Surgeon Consult Results Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Co-Management Transfer of Care Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Sample Post-Operative Exam and Medication Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Cataract/Implant Post-Operative Exam Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Payment Authorization Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Introduction

Patients choosing co-management for their pre- and post-operative surgical care experience the benefits of continuity of care by their Primary Eye Care Provider (PECP) and convenience. This manual outlines the process for the co-management treatment of cataract and implant surgery patients. Together with some of California's most experienced cataract and implant surgeons, co-managing doctors of optometry can provide high quality care for cataract and implant patients, consistent with patient needs and desires. The following guidelines comply with applicable state and federal statutes and regulations regarding co-management of patient care and referral arrangements.

1. The selection of an operating surgeon for patient referral will be based on providing the best potential outcome for the patient. Financial relationships between providers will not be a factor.

2. The patient's right to choose the method of post-operative care will be recognized and will be consistent with the best medical interest of the patient.

3. Co-management of post-operative care will be determined on a case-by-case basis and not prearranged. The patient will be advised prior to surgery of potential post-operative management options.

4. Co-managing doctors will be ODs or MDs licensed to practice in California. 5. The transfer of post-operative care will always be clinically appropriate and depend on

the particular facts and circumstances of the surgical event. 6. Following surgery, transfer of care from the operating surgeon to a co-managing

provider will occur when clinically appropriate at a mutually agreed upon time or circumstance, and such time will be clearly documented via correspondence and included in the patient's medical record. This information will be included in the referral letter from the ophthalmic surgeon to the co-managing provider at the time of transfer of care. 7. The operating surgeon and the co-managing provider will communicate during the postoperative period to assure the best possible outcome for the patient. 8. Compensation for care will be commensurate with the services provided. Cases involving care for Medicare beneficiaries will reflect the proper use of modifiers and other Medicare billing instructions.

Step-by-step instructions and co-management forms are provided in the following section of this manual.

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Step-by-Step Process for Cataract Co-Management

1. q The referring optometrist performs the following: a. q Perform exam and identifies need for cataract surgery. b. q Educate the patient regarding the process of cataract surgery and discuss fees. c. q Discuss the typical co-management treatment plan and explain what care will be provided by the ophthalmic surgeon and the optometrist. Provide the patient with patient Handout (page 11). d. q Fax the pre-op examination and consultation request Form (page 13) to the COLA MD's office. e. q Have the patient sign the payment authorization Form (page 19) and the co-management consent Form (page 14) and fax the forms to both the MD's office and the COLA administrative offices.

2. q The Patient Coordinator (PC) at the MD's office performs the following: a. q Contact the patient and schedule an appointment for a consultation. b. q Notify the referring optometrist of the date of the consultation appointment, or the reason the patient declined to book the appointment, if applicable.

3. q The surgeon performs the following: a. q Pre-op exam and pre-op testing b. q Patient education and procedure selection c. q Faxes Surgeon consults results Form (page 15) to the co-managing eye care provider, advising the date of surgery, patient findings and plans, and any other pre-op care instructions. d. q Complete the Transfer of care Form (page 16) (when deemed medically appropriate), which includes surgery information and findings from the previous post-operative visits and faxes the form to the co-managing PECP.

4. q The co-managing PECP performs the following: a. q Following each post-operative visit, fax cataract/implant post-operative Form (page 18). Usually at the one month visit, the PECP will perform the post-operative follow-up, refraction and prescribing glasses, if necessary. b. q Bill third party payers for their portion of the post-operative treatment. Information regarding billing the PECP's portion of the co-managed care is provided on pages 14-16 of this manual.

5. q Payment for upgraded IOLs or private pay services will be collected from the patient by the California Optometric Laser Associates and reimbursement will be made by COLA, inc. to the PECP for those services.

The MD's office will communicate with the referring provider via fax for any matter regarding their patients, including procedure outcomes and any follow-up visits seen by the surgeon.

please contact the md directly for any questions regarding individual patient care or complications.

For ordering necessary supplies, questions regarding payment or general questions about cola comanagement programs, please contact a cola representatives at 510-895-9657.

We look forward to bringing together a partnership with our affiliated co-managing doctors in which cataract and implant patients can receive the best and most convenient available care.

Disclaimer: Every effort has been made to assure that all information contained in this manual is accurate, appropriate and current with the standards of care in the State of California. COLA takes no responsibility for the payment of individual insurance claims by Medicare or any other third party insurance. All medical care and advice is at the discretion of each MD's and OD's clinical judgment.

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Treatment Protocols

The volume of cataract surgeries will continue to increase as the population ages. So, we must stay educated in cataract surgery protocols and possible complications. A thorough pre-op exam and treatment of any existing problems may prevent complications from occurring after surgery. Though serious complications are rare, it is also important to know what post-op complications can occur and how you can manage them, and when it is time to refer the patient back to the surgeon.

PRE-OP EXAM

General Health

The first key to managing complications is to find ways to avoid them altogether or at least decrease their likelihood. This starts with astute observations during your pre-operative exam, and that starts with a general health history. Understanding the patient's overall health at the time of surgery can help chart the strategy of the procedure. It can also help predict and explain the prognosis and course of recovery.

Ask about systemic diseases that affect healing after cataract surgery, particularly autoimmune and collagen vascular diseases such as rheumatoid arthritis, lupus and diabetes. Patients with rheumatoid arthritis are at risk for abnormal healing. Examine the patient's hands for telltale signs. Arthritis or lupus may increase the inflammatory response after surgery, resulting in pronounced postop inflammation, high intraocular pressure, cystoid macular edema or even a corneal melt near the incision.

If the history is positive for any of these diseases, you may have some options to help provide that patient with a normal post-op healing course. The surgeon could consider more inert intraocular lenses (IOLS) made of acrylic instead of silicone, which would reduce a potential source of inflammation. Be prepared for the need to increase the steroid dosing early in the post-op period to control the ensuing inflammatory response.

There are some concerns specific to diabetic patients: poor wound healing, and the risk exacerbating existing proliferative retinopathy and diabetic macular edema. diabetics with poor blood sugar control may have a slower recovery following surgery. Some may benefit from delaying surgery until their diabetes is under control.

Anterior Segment Concerns

Examination of the eyelids prior to surgery should not be overlooked. The leading cause of endophthalmitis is the introduction of bacteria into the eye from the conjunctiva and ocular adnexa. It's important to diagnose and manage blepharitis and meibomitis prior to cataract surgery.

Also, look for other lid conditions such as entropion, ectropion and lower lid laxity. Improper apposition of the lower eyelid can contribute to an inadequate clearing of bacteria, which also increases the risk of endophthalmitis. You may want to refer these patients for an oculoplastic consult prior to cataract surgery.

Patients with cranial nerve dysfunction such as a seventh-nerve palsy, which results in an incomplete blink, are also at risk for corneal exposure problems and poor wound healing after cataract surgery. Lubricating ointments and a referral for surgical intervention may be indicated for these patients.

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