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Evaluation, Diagnosis, Coding Evaluation, Diagnosis, Coding and Reimbursement Associated and Reimbursement Associated with Marco 3D Wavewith Marco 3D Wave

Kim Castleberry, ODKim Castleberry, ODPlano Eye AssociatesPlano Eye Associates

33--D WaveD Wave ~ making it pay~ making it pay

ProProcedurescedures--drives proceduresdrives proceduresProductiProductivityvity--automating refraction and automating refraction and streamlining medical carestreamlining medical careProficiencyProficiency--making you a better doctormaking you a better doctor

The The ChallengeChallenge--getting itgetting it

ProfitabilityProfitability

ProceduresProcedures92XXX Exams92XXX Exams9202592025--$30 per eye$30 per eye9228592285-- External photographyExternal photography $50$5092499; Wa92499; Wavevefront analysifront analysiss

Variable $$Variable $$

Coding Coding 33--D WaveD Wave

3D Wave for Medical care3D Wave for Medical care

When patients present with a chief complaint that may indicate When patients present with a chief complaint that may indicate pathology, or have signs or symptoms of pathology, or have a pathology, or have signs or symptoms of pathology, or have a medical history of pathology, a 3D wave diagnostic exam with medical history of pathology, a 3D wave diagnostic exam with interpretation and report may be considered a medically interpretation and report may be considered a medically reimbursable procedure.reimbursable procedure.

The Marco 3D Wave Diagnostic exam software records The Marco 3D Wave Diagnostic exam software records an image capture and analysis process that can be used to an image capture and analysis process that can be used to accurately diagnosis a wide range of ocular conditions. This accurately diagnosis a wide range of ocular conditions. This combined with the physicians interpretation and report combined with the physicians interpretation and report provides evidence which can then be used to support provides evidence which can then be used to support reimbursement of claims, if required.reimbursement of claims, if required.

Medical NecessityMedical Necessity

Reason for dReason for diagnosticiagnostic test?test?Directly stated or easily impliedDirectly stated or easily impliedWill it effect diagnosis or treatment?Will it effect diagnosis or treatment?

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General payment policyGeneral payment policy

Medicare reimburses reasonable and Medicare reimburses reasonable and medically necessary care to diagnose medically necessary care to diagnose and treat illness or injury or to improve and treat illness or injury or to improve the function of a malformed body the function of a malformed body member.member.

Specific payment policySpecific payment policy

CPTCPT -- Procedure codesProcedure codesICDICD -- diagnostic codesdiagnostic codesNCDNCD -- National carrier directivesNational carrier directivesLCDLCD -- Local carrier directivesLocal carrier directivesThe golden ruleThe golden rule -- check carrier contractscheck carrier contractsProfessional judgmentProfessional judgmentBecome your own coding expertBecome your own coding expert

OpinionsOpinions

Are not payment policyAre not payment policyEvery one has oneEvery one has oneAnything outside of NCD LCD CPT and Anything outside of NCD LCD CPT and ICD is opinionICD is opinion

33--D WaveD Wave Procedure codesProcedure codes

9202592025--RT RT Corneal topographyCorneal topography9202592025--LT LT Corneal topographyCorneal topography9228592285 External photographyExternal photography9249992499 Misc. ophthalmological codeMisc. ophthalmological codeWellness screening proceduresWellness screening proceduresMedical diagnostic proceduresMedical diagnostic procedures

WellnessWellness Screening Screening proceduresprocedures

Abbreviated technical componentAbbreviated technical componentInterpretation and report not requiredInterpretation and report not requiredReason for procedure was for well vision Reason for procedure was for well vision purposespurposesUsual and customary fees usually lower Usual and customary fees usually lower reflecting the reduced servicereflecting the reduced service

Medical diagnostic Medical diagnostic proceduresprocedures

Usually billed with 92XXX Office visitUsually billed with 92XXX Office visitNeeds interpretation and reportNeeds interpretation and reportMedical necessity Medical necessity

Reason for dReason for diagnosticiagnostic test?test?Directly stated or easily impliedDirectly stated or easily impliedWill it effect diagnosis or treatment?Will it effect diagnosis or treatment?

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Imaging medical necessityImaging medical necessity

It is not necessary to photograph a It is not necessary to photograph a condition simply to document its condition simply to document its existence but rather to provide a baseline existence but rather to provide a baseline to compare later is the condition has to compare later is the condition has changed and requires a change in changed and requires a change in treatment.treatment.It may be necessary to photograph a It may be necessary to photograph a condition to help establish a proper condition to help establish a proper diagnosis diagnosis or provide treatment.or provide treatment.

92025; Corneal 92025; Corneal TopographyTopography

CPT states unilateral or bilateralCPT states unilateral or bilateralMedicare is paying per eyeMedicare is paying per eye9202592025--RTRT9202592025--LTLT

92285; external 92285; external photographyphotography

The quality of the image should be of sufficient The quality of the image should be of sufficient quality to be clinically relevant and graphically quality to be clinically relevant and graphically equivalent to a photograph. Images can be equivalent to a photograph. Images can be film based or digitally stored.film based or digitally stored.Requires an interpretation and reportRequires an interpretation and reportUnilateral or bilateral feeUnilateral or bilateral fee92285 qty 1 for unilateral or bilateral92285 qty 1 for unilateral or bilateralAppropriate ICD diagnosisAppropriate ICD diagnosis

92499; Wavefront 92499; Wavefront

9249992499--RTRT9249992499--LTLTput Wavefront analysis in area 19put Wavefront analysis in area 19Attach 3D wave print out and Attach 3D wave print out and interpretation and report to claim and interpretation and report to claim and mail inmail inUse appropriate ICD codeUse appropriate ICD code

Subjective visual Subjective visual disturbancesdisturbances

Dont have to do everything for just an office Dont have to do everything for just an office visit!visit!Special testing is frequently necessary to Special testing is frequently necessary to correctly diagnosis and treat many vision correctly diagnosis and treat many vision problemsproblemsDont have to do it for freeDont have to do it for freeDont have to do it at all for the freeloadersDont have to do it at all for the freeloaders

Subjective visual Subjective visual disturbances 368.1Xdisturbances 368.1X

368.10 Unspecified368.10 Unspecified368.11 Sudden vision loss368.11 Sudden vision loss368.12 Transient vision loss368.12 Transient vision loss368.13 Visual discomfort368.13 Visual discomfort368.14 Distortions of size or shape368.14 Distortions of size or shape368.15 Other distortions and entopic368.15 Other distortions and entopic

PhotopsiaPhotopsia, Refractive (, Refractive (diplopia,polyopiadiplopia,polyopia), halos), halos

368.16 psychophysical disturbances368.16 psychophysical disturbances

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ProductivityProductivity

Diagnostic productivityDiagnostic productivity3D Wave 3D Wave Review SoftwareReview SoftwareRefractionRefractionMotorized RefractionMotorized RefractionEMREMR integrationintegrationDecreased dependence on tech staffDecreased dependence on tech staff

Diagnostic productivityDiagnostic productivity

Technical component is already doneTechnical component is already doneEasy to train to do proceduresEasy to train to do procedures

OPD software into the OPD software into the exam roomsexam rooms

Critical to driving medical procedures Critical to driving medical procedures productivelyproductivelyPatient education is easierPatient education is easierReduces printer costsReduces printer costsWow factor for patient is highWow factor for patient is highA big step toward a technology integrated A big step toward a technology integrated practicepractice

RefractionRefraction

30 second refractions on most patients30 second refractions on most patientsNo refraction on a few patients No refraction on a few patients Normal refractions on a few patientsNormal refractions on a few patientsEasy to delegate refractionEasy to delegate refractionEasier to reclaim refraction to improve Easier to reclaim refraction to improve productivityproductivityPatients (most) like not answering which is Patients (most) like not answering which is better one or two if educated properlybetter one or two if educated properlyPt education is the keyPt education is the key

Motorized refractorsMotorized refractors

Streamline refractingStreamline refractingMakes the 30 second refraction a realityMakes the 30 second refraction a realityPatient love itPatient love itMakes refracting funMakes refracting funAnother critical step toward the Another critical step toward the technology integrated practicetechnology integrated practiceInterfaces with EMRInterfaces with EMR

EMR integrationEMR integration

Officemate ExamWriterOfficemate ExamWriterNeed the refracting suiteNeed the refracting suiteEliminates transcription errorsEliminates transcription errorsSpeed data entrya lot!Speed data entrya lot!Easy interpretation and reports with 3D Easy interpretation and reports with 3D wave data capture and analysiswave data capture and analysis

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ProficiencyProficiency

Providing higher level of reimbursable Providing higher level of reimbursable carecareHD ExamsHD ExamsMaking you a better doctorMaking you a better doctor

3D Wave Dx conditions3D Wave Dx conditions

Corneal degenerations, dystrophies and opacities.Corneal degenerations, dystrophies and opacities.Conjunctival conditions; pterigiumConjunctival conditions; pterigiumOcular surface diseaseOcular surface diseaseMedia Opacities; cataracts and vitreousMedia Opacities; cataracts and vitreousIOL complications; tilted/decentered IOLs, small OZs, IOL complications; tilted/decentered IOLs, small OZs, Capsular defectsCapsular defectsRetinal deformity; staphylomaRetinal deformity; staphylomaSubjective visual disturbancesSubjective visual disturbancesPupil abnormalitiesPupil abnormalitiesIris abnormalitiesIris abnormalities

ICDsICDs371.4X; corneal degenerations371.4X; corneal degenerations371.5X; corneal dystrophies371.5X; corneal dystrophies371.0X; corneal opacities371.0X; corneal opacities371.2X; corneal edemas371.2X; corneal edemas371.6X; keratoconus371.6X; keratoconus371.7X; corneal deformities371.7X; corneal deformities743.41; anomalies of cornea 743.41; anomalies of cornea 371.82; corneal disorder due to CL371.82; corneal disorder due to CL371.9; unspecified corneal disorder371.9; unspecified corneal disorder372.4X; pterigiums372.4X; pterigiums374.0X; eyelid entropions374.0X; eyelid entropions374.1X; eyelid ectropions374.1X; eyelid ectropions374.2X; lagophthalmoss374.2X; lagophthalmoss374.3X; ptosiss374.3X; ptosiss

364.6X; Iris cysts364.6X; Iris cysts364.7X; Iris adhesions364.7X; Iris adhesions366.00; Cataracts366.00; Cataracts366.5X; after cataracts366.5X; after cataracts368.2; diplopia368.2; diplopia379.4X; pupil anomalies379.4X; pupil anomalies379.2X; disorders of vitreous379.2X; disorders of vitreous379.3X; aphakia & lens disorders379.3X; aphakia & lens disordersV41.0; problems with sightV41.0; problems with sight996.5X; graft/IOL complication996.5X; graft/IOL complication

Case examplesCase examples

PterigiumPterigiumIrregular cylIrregular cylIOL complicationsIOL complicationsKeratoconusKeratoconusCataractCataractNyctalopiaNyctalopiaPC opacitiesPC opacitiesSubjective visual disturbancesSubjective visual disturbances

PterigiumPterigium

9228592285OrOr9202592025--RTRT9202592025--LTLT

ICD: 374.32ICD: 374.32

PterigiumPterigiumPost opPost op

92285922859202592025--RTRT9202592025--LTLT

ICD:V45.69ICD:V45.69Post eye sxPost eye sx

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Irregular cylIrregular cyl

Watch post cat sxWatch post cat sx92285922859202592025--RTRT9202592025--LTLT

ICD: V45.69 post eye sxICD: V45.69 post eye sxICD: 367.22 irreg cylICD: 367.22 irreg cylICD: 743.41 anomaliesICD: 743.41 anomalies

IOL entrapIOL entrap

9228592285ICD: 996.53ICD: 996.53IOL complicationIOL complication

Pre dilationPre dilation

IOL OK at prelimIOL OK at prelim

KeratoconusKeratoconus

92285922859202592025--RTRT9202592025--LTLT

ICD: 371.60ICD: 371.60keratoconuskeratoconus

CataractCataract

92499 Wavefront92499 Wavefront9228592285

ICD:366.15ICD:366.15Cortical cataractCortical cataract

NyctalopiaNyctalopia

OOD: D: plplanoano 0S:0S:--2.752.759228592285

ICD:368.60ICD:368.60NyctalopiaNyctalopia

ICD:379.40ICD:379.40Abnormal pupilsAbnormal pupils

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The other eyeThe other eyeNyctalopiaNyctalopiaRRxx for other eyefor other eyeRx OD:Rx OD:--.50 OS: PL.50 OS: PL

PC opacityPC opacity

922859228592499 Wavefront92499 Wavefront

ICD:366.51ICD:366.51PC opacityPC opacity

ChallengesChallenges

ODs generally think 3D Wave is a high end auto ODs generally think 3D Wave is a high end auto refractor.refractor.ODs dont understand is provides medically ODs dont understand is provides medically reimbursable proceduresreimbursable proceduresODs dont understand how it can enhance their well ODs dont understand how it can enhance their well vision practicevision practiceDifficult to learn to utilize the technologyDifficult to learn to utilize the technologyODs have a hard time billing what they and technology ODs have a hard time billing what they and technology are worthare worthIncreasing deductiblesIncreasing deductiblesODs have a hard time ordering tests vs selling testsODs have a hard time ordering tests vs selling tests

Questions?Questions?

Kim Castleberry, ODKim Castleberry, ODwww.PlanoEye.comwww.PlanoEye.comKim.Castleberry@gte.netKim.Castleberry@gte.net