Ophthalmology and Optometry Coding Alert

Question: We recently contracted with an optometry practice for co-management - our surgeon performs surgical procedures and the optometrist performs post-operative care. We created a contract with the optometry practice, but they refuse to sign it. Can you advise?

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Answer: Participating in a co-management situation can provide benefits to the practice and the patient, but can also present legal challenges, one of which involves signing contracts.

If the surgeon and the patient agree that it's in the patient's best interest for the optometrist to handle the post-operative care, your first step is to ensure that you aren't violating the Stark Law, which prevents you from referring patients to other providers with whom you have a financial relationship. Then, be sure that your practice and the optometrist haven't agreed to any type of "quid pro quo" referral exchange, which is also not appropriate.

Most consultants and attorneys advise against using written agreements for co-management situations, because the agreement indicates there is a standing order for your surgical patients to go to that optometrist after surgery. In reality, any decision to co-manage should be made on a patient-by-patient basis, based on the patient's wishes and clinical status, so a written agreement is not necessary or appropriate. Typically, this arrangement of co-management should be discussed with the patient prior to the surgery and agreed to by the patient. The arrangement should absolutely be made on the basis of patient desire or in the best interests of the patient.

For example, the patient wants surgery with an ophthalmologist whose office is 50 miles from her home but would prefer routine post-op care with the optometrist, who is within 15 miles of her home. This arrangement serves the best interests of the patient and is agreed to in advance by the patient.

If you do agree to co-manage a patient, the ophthalmologist can create a document outlining the terms of his clinical protocol, generally explaining how many times he likes the patient to be seen after surgery, because that's not an agreement to refer, it's an agreement on the protocols for care, when and if one refers to the other.