By Arthur B. Epstein, OD, FAAO
As spring allergy season approaches, take steps to enhance and publicize your ocular allergy services. Providing this as primary care creates a revenue stream not to be overlooked.
TheValue to Your Practice
The coding aspect for ocular allergy consists of nothing more than an E/M (evaluation & management) visit code in most cases. Most likely the level of the code is a 99202/12 or a 99202/99212, 99203/13 based on meeting the criteria for each visit. Remember to match the CPT code with an appropriate current ICD-9 diagnostic code, and to choose a diagnosis with the highest level of specificity (five digits). Follow-up evaluations are essential to determine the efficacy of your medical therapy.
The Ocular Allergy Incidence/Annuity Model
The American Optometric Association says that the average practitioner has about 3,100 patient encounters in a given year. Allergy studies done demonstrate that about 52 percent of the US population has overall allergies and 83 percent of those have symptoms consistent with ocular allergy. If you do the math, that would mean that nearly 42 percent of the US population has symptoms consistent with ocular allergy. Thus, the average OD can expect to see about 1,287 ocular allergy patients per year.
In the first year of care, the ocular allergy patient is typically seen two times in addition to their comprehensive examination and refraction. In ensuing years, this visit would be at the six-month interval. Based upon 2012 CMS national average allowable amount for a 99203 (approx. $70.70) this would represent an economic potential of approximately $182,000 per year just from ocular allergy revenue. That would mean that you would have to have a 100 percent capture rate which is highly unlikely. So assuming that 30 to 50 percent of your patients are compliant, that would still represent about $55,000 to $91,000 of unrealized economic return to your bottom line.
Ocular allergies are prevalent and part of the primary area of care that we provide.Treating ocular allergies iseconomically beneficial, as well, and that is hardly something to sneeze at.
—John Rumpakis, OD, MBA
Practice Resource Management, Inc.
Ocular allergy is among the most common conditions seen in the optometric office. It is also among the most under-diagnosed and frequently mismanaged conditions we encounter. What makes allergy such an opportunity for us is that it is easily diagnosed, is extremely disruptive to our patients and is effectively treated with minimal risk.
Ask Patients aboutOcular Allergy Symptoms
Ocular allergy is under-diagnosed by many ODs for a variety of reasons. The first and most obvious is that patients often don’t realize that we treat allergy or that we can prescribe medications offering superior relief of eye symptoms compared to oral or over-the-counter (OTC) products. Put simply, if we don’t ask, they won’t tell.
Environment Plays a Role
The second reason that ocular allergies are under-diagnosed: Our offices are air conditioned, and patients usually are symptom-free when breathing our filtered air. Literally out of sight, their allergy symptoms are out of mind.
Communicate Your Better-than-OTC Offering
There are many OTC products, and patients usually don’t realize that taking an OTC product is rarely the most effective or the least expensive route to relief.We can offer a better alternative, and we need to not feel guilty about selling ourselves and products that are in the patient’s best interests. Prescription medications for ocular allergies generally have numerous advantages over OTC products, including effectiveness, per-dose cost and even patient compliance and satisfaction. Some OTC drugs cause rebound which leads to abuse. It is our job as clinicians to educate patients about the difference between OTC and Rx products and direct patients to those that provide the best outcome for them.
Carefully Choose Prescription Meds
Understand the patient’s experience. Allergy can be debilitating. Eye allergy is especially disruptive. Don’t ask patients to use something that feels worse than the problem you are trying to treat. Not all medications are created equal. Burning, stinging and irritation do not feel good and are exit ramps from effective therapy.
Create a Livable Treatment Plan
Less is more– the less frequent the dosing, the happier and more satisfied the patient. They are also likely to be more compliant. This is true for systemic therapies as well as ocular medications. Once a day is the best way.
Related ROB Articles
Arthur B. Epstein, OD, FAAO, is a contributing editor of Review of Optometry, executive editor of Review of Cornea & Contact Lenses, and chief medical editor of Optometric Physician. He is a partner in North Shore Contact Lens & Vision Consultants in Roslyn Heights, NY. To contact him: firstname.lastname@example.org.