When pre-testing is not the best exercise

Consider what has the most value for patients and the practice.

This month’s column topic was suggested to me by a conference speaker. This person talked about how to make your IOL measurements the best they can be and went through all the ways they can go astray.

That got me thinking about how influential we are as technicians. For instance, when to measure for the IOL can have serious implications in terms of payment, coding, accuracy, and efficiency. Consider:

  1. Has the decision for the surgery itself been made or not?
  2. Has the provider encountered the patient and ordered the test, thus making it potentially billable to insurance?
  3. Is it an efficient use of technician and surgeon time to test prior to the provider’s encounter?

Let’s deal with these real concerns in order.

Surgery is not yet set

Although the patient might be referred by another provider, how can your surgeon decide that surgery is indicated before examining the patient and discussing the options with the patient personally? One of these options is to go with glasses and defer surgery. While most patients do decide to go with surgery, that is not universal.

The other consideration here — and it is very real — is that people who have dry eye or other ocular surface disease might not yield accurate results. So, your meticulous measurements might have been in vain. Cataract surgeons who need to treat these surface conditions may defer surgical measurement for up to 6 weeks so that the surface is maximally benefited and, therefore, most accurate in terms of IOL measurements and the resultant calculations. Not every patient, of course, falls into this surface issue concern, but we may not know if they do, because symptoms and physical signs of tear film and surface disease don’t correlate well, according to the TFOS DEWS II report ( ).

The test is not yet billable

There is a financial consideration of which to be aware. An order for a test is required for it to become a billable service to payers. Put another way, not having a specific diagnostic test order for patients and their unique conditions makes nearly all tests “screening” and therefore not an insurance benefit. You might have heard the term “standing orders.” That is another way to say “screening” to payers. OP published a Coding column on this, and it is worth revisiting ( ).

Of course, orders for tests are most often done after the doctor sees the patient. If the patient needs to come back to see the result of the treatment, let the doctor see the patient right after work up with no drops. Then, the doctor can order these measurements and you’ll do what is best for all.

The measurements may not be accurate

I completely understand surgeons wanting to discuss all the surgical options, including whether astigmatism surgery is on the table, but most of us have personally seen astigmatism undergo a significant change after the ocular surface is improved (and the cylinder change can be an increase or a decrease). As technicians, these measurements require real attention to detail. Spend the time when it has the most value for our patients and practice. Surgeons could then have a more meaningful discussion as well.

Not all patients have ocular surface issues, but a larger percentage of cataract surgery candidates will. Doing testing without an order makes it impossible to bill a payer for those tests. Efficiency demands the best use of the surgeon and technician time. And, of course, our patients depend on all of us.

Screening or pre-testing is not always bad. In some cases, it can improve efficiency. But, doing so comes with a financial consideration for which we should all be aware. For some things, like IOL calculation measurements, pre-testing is not the best exercise.

As always, “good coding to you.” OP