Two issues have been rattling around in my pea brain recently: 1) contact lens-related complaints that really don’t have anything to do with contact lenses, and 2) the increasing amount of time that eyecare practitioners spend in non-compensated care. Let’s talk.

Is It Really a Contact Lens Issue?

Over and over, we have patients show up in our offices with complaints about their vision that they attribute to their contact lenses. Sometimes, these presentations happen very soon after a patient has had a comprehensive evaluation. You might assume that there could be no way that someone you just saw two weeks ago could possibly develop a problem, right?

Wrong. I once watched a hydrops happen in real time at the slit lamp. The odds are astronomical against such things, but when the probability ain’t zero, stuff happens.

So, to get to the source of the problem, begin where you should always begin—with your staff on the telephone or electronic reception. The first thing you need is a clear understanding of what constitutes a medical emergency. We have a triage policy posted at the front desk that instructs the staff on what patient complaints trigger an immediate return. Beyond that, your staff has to understand that, sometimes, people who complain about their contact lenses may actually be complaining about their eyes.

The staff, when sensitive to such possibilities, will approach patient complaints about contact lenses differently. Most of the time, a contact lens complaint is a contact lens complaint, and the more contact lens patients that you see, the greater the probability that a complaint is due to contact lenses. However, you should be ever vigilant to the other possibilities.

Just in the last month, I have had patients who presented with complaints about their contact lens wear who actually had a swollen optic nerve, an incomplete macular hole, metallic corneal foreign bodies, an A1C of 12.5%, decompensating vertical heterotropia, and, my favorite, zoster keratitis. Is your practice prepared to diagnose these conditions and more?

Non-Compensated Patient Communication

The second thing that is really starting to concern me is the amount of time that I (and I assume everyone else) am spending communicating with patients in ways that are not compensated. The number of phone calls, emails, and now text messages that are sent to my practice is taking up a greater and greater amount of my time. I am not set up to monetize those conversations.

There are evaluation and management CPT codes that can be used; 99441 to 99443 can be used for telephone consultations of varying lengths, and 99444 can be used for online consultations. However, I have not had much luck with these codes being covered services under most plans. Some recommend using the –QT modifier for these types of services, but the plain language of the modifier describes a storage on tape by an analog recorder. I don’t really see how that fits here.

Recently, I was shown an application that creates a secure portal for these communications that supposedly will bill insurance. While I have not yet seen buy-in on the part of insurance companies for these types of technologies, it is probably the way things will go in the future.

Much negotiation and regulation will define what will and will not work in this area. Stay tuned. CLS