Ophthalmology and Optometry Coding Alert

The Office of Inspector General (OIG) has released its 2003 Work Plan and it looks as if ophthalmologists and optometrists won't be overlooked thanks to their use of modifiers -54 (Surgical care only) and -55 (Postoperative management only) when reporting cataract surgery co-management. According to the OIG, if optometrists refer surgical cases depending on whether the patient will be referred back to them for postoperative care, they will be assessed for violations of anti-kickback laws. The American Academy of Ophthalmology (AAO) and the American Society of Cataract and Refractive Surgery (ASCRS) outline the proper and ethical guidelines for co-management. According to the paper, co-management is justifiable when the surgeon is unavailable (i.e., ill, on leave, traveling) or the patient can't travel to the surgeon's office due to illness or distance.

Surgeons are instructed to inform the patient of any prearranged postoperative management plans prior to surgery and have the patient "voluntarily consent to this in writing," then to document the consent process in the medical record, including "the reason for the transfer of care, the qualifications of the healthcare provider who will render the postoperative care, and any special risks that may result from this arrangement."

The AAO and ASCRS also advocate the following guidelines for co-management:

1) co-management not be done as a matter of routine policy,

2) the patient be informed of any financial implications associated with co-management,

3) the patient be assured access to the surgeon during the postoperative period at no additional cost,

4) the surgeon follow the patient until postoperatively stable,

5) the transfer of care must not occur unless clinically appropriate and in the patient's best interest, and

6) fees for services must reflect fair-market value.