Medical Model

Opportunities in Treating Ocular Allergies

By Jeanmarie Davis, OD

Treating ocular allergies, and publicizing your services, is essential to betterserving a growing portion of your patient base.

ROB Bottom Line

Jeanmarie Davis, OD, of Hialeah, Fla., finds ocular allergy services a winner for her patients and her practice.

Ocular Allergies
10 to 15 percent patients affected in spring and fall.

Exam Fee
$89, if diagnosis is made during annual exam; $39 per always-required follow-up visits.

Chair Time
10 to 15 minutes of chair time, at most, for each follow-up visit.

Calculate Ocular Allergy Opportunity
Ocular allergy treatment is a growing segment of my practice. In the spring and fall, 10 to 15 percent of the patients who visit my officeweekly are challenged by ocular allergies. During those times of the year, the influx of needs from these patients boosts my overall patient visits by 2 to 3 percent. Many of these patients do not realize they have ocular allergies, and just make an appointment for a regular check-up, or annual comprehensive exam, for which I charge $89. If a diagnosis is made of ocular allergies, I always require follow-up visits,for which I charge $39 each, to ensure the patient is compliant with my treatment plan, and to see thathe or she is improving. Each follow-up visitcosts me approximately 10 to 15 minutes of chair time, at the most.

Code for Ocular Allergies

Making ocular allergies a win for your patients and practice requires that you know the correct insurance billing codes.

Common ocular
allergy code


Code-able Diagnoses
General ocular allergies, chronic allergies, allergic conjunctivitis.

*Keep in mind preferred diagnosis terminology will vary depending on coding books or theelectronic health program you use, but, chances are, you will be guided to use one of the diagnoses listed above.

Ask About Symptoms
To tap into this “budding” opportunity, you first must draw out of patients that they have ocular allergies. Rather than asking, “Do you have ocular allergies?” ask about symptoms on your patient in-take form when they check-in at your front desk. Symptoms I list in the form, which patientsare asked to mark if they experience, include itchy eyes, red eyes, tearing, repeated rubbing of their eyes, congestion and seasonal or environmental allergies they already know they have. In addition, I always ask about these symptomswhen they are in my exam chair. They may have been rushing through the intake form, or didn’t realize those are the symptoms they suffer from until I speak face-to-face with them about it.

Get Credentialed By Medical Plans
Many vision plans do not offer reimbursement for treatment of ocular allergies, so to make this a growing segment of your practice, you will need to get credentialed to be on the medical panels of Medicare, Medicaid and the private medical insurance companies that your patients most frequently use. Becoming a member ofa medical insurance provider’s “medical panel” simply means you arecredentialed as a medicalcare provider, as opposed to only a vision care provider.To do that, contact each of these insurance providers, and ask specifically how you can most easily apply to the provider’s medical panel. If you do not specify “medical panel,” the operator who answers your call probably will assume you only want acceptance to the provider’s vision plan panel. The application fee is typically around $50, with applications to the medical panel sometimes only accepted certain times of the year–similar to the way manypatients are only able to sign up or make changes to theirhealth plans during certain times of the year.

Since the process of contacting each insurance provider you are interested in and then filling out applications can be time consuming, you also can invest in a billing service to do this for you. I handled the application process when it was easy, but for providers with a more laborious application process, I enlisted an outsourced billing service, for which I paid a flat fee of $400. I provided thebilling service with a list of insurance providers Ihad trouble with, and they took it from there.ForODs whoneed more help with the process–who, say, may even need help identifying which insurance providers to apply tofor medical credentialing–there are other options. Some services, for instance, charge $400 to $600 with an additional $200 a month forup to 6 months to handleeverything from the identification of insurance providersthrough thewhole application process. In my case, baseline services were enough. I am currently on the medical panel of seven insurance companies, and am working to add additional credentials so more of my patients will be covered.

Drum Up Physician Referrals
To get your ocular allergy services off to a strong start, contact primary care and pediatric physicians in your metropolitan area, introduce yourself and askfor their referrals. Many of these doctors are not well-versed in the treatment of eye conditions, such as ocular allergies, and will assume all inflammatory eye conditions only require antibiotic drops for treatment, which usually doesn’t solve the discomfort of ocular allergy patients. Since no doctor wants unhappy patients, and since they also may not feel it’s worth their exam room time to see patients with ocular discomfort, they probably will be more than happy toknow a local OD to make referrals to.

It also helps to create a flyer or information sheet to leave in primary and pediatric physician waiting rooms. Like your in-take form and exam chair questions, these flyers should focus on symptoms rather than the term “ocular allergies.” List the symptoms of ocular allergies on these materials, along with your contact information. It is likely that a patient with those symptoms will ask the doctor about it, and since you already have agreement for a referral, you know he or she will then encourage the patient to make an appointment to see you. The referral becomes self-generated by the patient, making it all the more powerful.

Related ROB Articles and Multimedia

Treating Ocular Allergies

Where is the Money in Ocular Surface Disease? In Your Exam Chair!

The Importance of Submitting High-Risk Diagnostic Coding
Jeanmarie Davis, OD, has an independent practice in Hialeah, Fla. She is an eye health pathology and medical model specialist. To contact her:

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