Northern Sights Newsletter
North Dakota Vol. 28 Issue 6 November/December 2016 Optometric Association 921 South 9th Street, Ste. 120 NDOA’s 2016-2017 NEWLY INSTALLED BOARD OF DIRECTORS Bismarck, ND 58504 Phone: 701-258-6766 Fax: 701-258-9005 E-mail: [email protected] Website: www.ndeyecare.com
2015 NDOA OFFICERS
Dr. Paul Dunderland President President President Elect Vice President Secretary/Treasurer Past President PO Box 169 Dr. Amy DuBois Dr. Darin Johnson Dr. Nate Shilman Dr. Krista Heil Dr. Blaine Burdick Bottineau, ND 58318 701-228-2219 President’s Message ~ Dr. Amy Mitzel-DuBois [email protected]
Dr. Blaine Burdick ell….here it is, my first official Director, Nancy Kopp, I am confident we President Elect article for the NDOA will have a successful year supporting our PO Box 888 W newsletter as your President. association and our profession. There are Devils Lake, ND 58301 many issues in the next year that need to be 701-662-2817 I am honored to serve our association as addressed that are vital to the success of our [email protected] President for 2016-2017. A little profession and the protection of the patients background on myself - I am from Valley we serve, Opternative, MIPS, MACRA, and Dr. Amy DuBois City, ND where I attended grade school, Vice President AMP to name a few: I will do my best to high school, and undergraduate at VCSU. I 3232 13th Ave. South promote our profession and our association attended Pacific University College of Fargo, ND 58103 and take on these issues. 701-280-3000 Optometry, graduating in 1998, and I’ve [email protected] practiced in ND for the past 18 years. I live Please feel free to contact me with any in Fargo with my husband, Chad, and our questions and/or concerns you have Dr. Darin Johnson two daughters, Paige and Mya. In my spare regarding actions or events occurring in our Secretary/Treasurer 1525 31st Ave. SW, Ste. E time, I enjoy working in my yard, relaxing association or profession. Minot, ND 58701 at our lake home, and attending my 701-857-6050 children’s sporting events. Inside This Issue [email protected] New Board Members I have learned so much over the past few Past President’s Remarks Dr. Taya Patzman years serving on the NDOA Board, with the Past President help of Blaine Burdick, Paul Dunderland, The Truth About Modifier -25 and Billing a Foreign Body Removal 1830 East Century Ave. Ste. 1 and Taya Patzmann, excellent past Bismarck, ND 58503 presidents I have served with. I do realize I Prescription Drug Monitoring Program 701-222-1140 have much yet to learn in the next year as I [email protected] Thank you for supporting your PAC! serve as your President. State Board of Optometry Candidates Nancy Kopp With the help of my current board members Executive Director and the tireless efforts of our Executive Northern Sights November / December Page 2 Welcome to the New Board! Dr. Blaine Burdick, Past President
timeline for each and discussed the support and opposition that G reetings NDOA members! I hope you all are may arise. enjoying this nice fall weather as 2016 is coming Our Board’s plan was to relay what we had learned from Mr. to a close. I’d like to share with you what your Walstad and share the concerns with our State Board prior to NDOA board has been working on over the past their meeting in October. We feel this language is very important few weeks. and will need a cohesive effort of both the NDOA and State Several months ago we agreed to work with the State Board to Board. We will continue to work together to make sure this introduce legislation to further define an eye examination, thus language is well-thought out, timely, and has as little opposition preventing Opternative or other kiosk-type “eye examinations” as possible. from coming into our state. Prior to our board meeting we were Unfortunately, this will be my last newsletter article! It has been informed, based on a recommendation from the State Board’s a pleasure to serve on the board the last five years, which has attorney, that these changes would be made by an administrative been the fastest five years of my life. Serving on the board has rule rather than statute. given me new respect and up-close view of organized optometry. Initially our board questioned the strength of an administrative It has enabled me to meet several amazing people at a state and rule and set up a conference call with AOA’s State and national level who volunteer their time and dedicate their lives as Government Relations Committee. Given our situation, AOA’s advocates for our profession. I will be grateful for many of the recommendations were that an administrative rule would be a relationships that have been formed over the past five years. good starting point, as Opternative is not currently operating in I leave you with a strong board ready to serve its membership. I our state. The NDOA Board also consulted with an attorney, would like to thank Dr. Krista Heil for giving back and John Walstad, who recently retired but has served on the North volunteering to serve on the board. Thank you to all of those who Dakota Rules Committee for the past 27 years. Mr. Walstad continue to make this profession better than you have found it! communicated with us the pros and cons about putting the language in statue vs administrative rule. He also laid out a
Thank You Industry Partners Candidates for the State Board of The 113th NDOA Annual Congress was supported in part by promotional grants from the following companies: Optometry
Gold Sponsor Johnson & Johnson T he NDOA is asked by the Governor’s Office, to make
recommendations, as to candidates to serve on the ND State Silver Sponsor BlephEx, LLC Board of Optometry. The current State Board OD members Essilor Laboratories are: Dr. Jeffery Yunker of Grand Forks, Dr. Jill Martinson- Precision Lens Redekopp of Minot, Dr. Tamera Mathison of Jamestown, Dr. VSP Global Brian Beattie of Bismarck and Dr. Taya Patzman of Bismarck. Corporate Dr. Alan King of Dickinson, serves as Executive Director.
Bronze Sponsor Traditionally, the NDOA has forwarded at least two names to ADO Buying Group the Governor. Dr. Jill Martinson-Redekopp’s term expires on Alcon June 30, 2017. Dr. Martinson-Redekopp has indicated she is Walman Optical interested in serving another 5 year term.
If any NDOA member is interested for nomination to serve, Congratulations! please contact the NDOA office by February 13, 2017. The members in attendance at the Membership Meeting, Dr. Paul Dunderland tentatively scheduled at the Bismarck Ramkota for March 30- 31, 2017, at our Legislative and Continuing Education “OD of the Year” Conference will vote on the recommendations.
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The Truth About Modifier -25 and Billing a Foreign Body Removal
A 34-year-old WM presents to your office with pain of the right A foreign body removal does have a zero-day global period, so eye for the past 3 days. It is red, watering, and photophobic. He if a rust ring removal is performed on another day you can bill was working on his car’s exhaust system a few days ago and his for it at that point. Because the reference material has conflict- eye has been irritated ever sense. You perform a slit lamp exam ing information, it is up to the provider to choose which code t and find a metallic foreign body imbedded in the cornea with a they feel is the most appropriate. If they are ever audited, they rust ring. You remove the foreign body with a 27G needle and would at least be able to say they are aware of the controversy use an Alger brush to remove the rust ring. A bandage contact and explain why they chose the code they did. I know many of lens is inserted and you schedule the patient for a follow up in you are thinking, “But I have billed both of these the same day two days. many times and they have always been paid.” Remember, just because it got paid, does not mean you did it right. Using a dif- ferent diagnosis code for each surgical procedure may get it past How do you code this encounter? the computer system, but an auditor may not be as forgiving.
significant, separately identifiable evaluation and
Modifier 25 management [E/M] service by the same physician Finally, the bandage contact lens (92071). If a bandage contact on the same day of the procedure or other service lens is used, you may bill for it along with the surgical code… usually. Some payers might consider a bandage CL as part of This is one of the most misunderstood coding situations I en- the wound care that is covered under the FB removal code. But counter, yet most doctors I speak with think they have it figured the majority do not. Another gray area here is that most payers out. The problem we have is that many “experts” have been (like Medicare) bundle the cost of the actual lens with the fee confusing us for many years by giving out information that is paid for 92071. Therefore, you do not bill separately for the ma- incorrect. The first concept we need to understand is that a sur- terials. If the payer does reimburse for the materials, you would gical code includes an office visit. That means in most situa- bill for them with 99070 Supplies and materials, or 92326 Re- tions, it is inappropriate to bill both an office visit (99000 or placement of contact lens, or the appropriate V code such as 92000) on the same day as you do a surgical code like a FB re- V2523 (contact lens, hydrophilic, extended wear). The only way moval (CPT 65222). The exception is when the office visit is a to know is to find a Local Coverage Determination or to call the “significant, separately identifiable evaluation and management specific payer. [E/M] service. Meaning…if the office visit is unrelated to the surgery, then you can bill both by adding -25 to the office visit code. For example, you could bill both if a patient is in the of- So, how do you properly code for the above case? fice for a 6-month glaucoma check and they happen to also have a FB that needs to be removed. The office visit would have the Initial Visit glaucoma diagnosis code and the FB removal would have the CPT: 65222 - RT (Removal of foreign body, external eye; corne- FB diagnosis code. But if the office visit’s diagnosis code is for al, with slit lamp) any reason related to the diagnosis used for the surgery, it would not holdup in a review. During a review and auditor would look ICD-10: T15.01A (Foreign body in cornea, right eye, ini- at a diagnosis like “pain in and around the eye” and very easily tial encounter) determine that it was caused by the piece of metal that was re- CPT 92071 – RT (Fitting of contact lens for treatment of ocular sur- moved. And as a result, they would recoup the office visit pay- face disease) ment. ICD-10: T15.01A (Foreign body in cornea, right eye, ini- tial encounter) The next very common error in this situation is that the doctor Follow Up will also bill 65435 (removal of the corneal epithelium) on the 99000 or 92000 code that best describes the care provided. same day if they use an Alger brush. This part does get a little more confusing, but most sources will state that if this is done at the same time as the FB removal it is bundled together and you should only bill 65222. If the patient develops a rust ring a few days later and you perform the debridement at that time, you may bill 65435 at that point. However, some sources (CPT As- sistant) states in one reference that you should simply bill 65222 again because the rust ring is technically a foreign body. The point here is that you should not bill them both on the same day.
Northern Sights November / December Page 4 Executive Director Message ~ continued…. From the Desk of Your Director funded as a NDOA benefit, as well as a partial grant from the ~ Nancy Kopp ~ Optometric Foundation of North Dakota, will benefit NDOA members from the increased advertising and online presence that TAYE provides. The Contact Lens Consumer Health Protection Act (S.2777), the “Politics as Usual! act to crack down on unscrupulous internet-based contact lens Executive Director’s Year in Review!” sellers, was introduced with support of AOA, NDOA, and other major contact lens companies. This bill calls for bolstering pa- Fall back…..the leaves are changing color and we will soon turn tient safety requirements, increasing accountability for internet the clocks back in time. Where did the last 10 months go? contact lens sales, and reinforcing the distinction that contact Fall is the time when the NDOA convenes for the annual con- lenses are medical devices and should be treated that way. gress; this year’s meeting in Bismarck/Mandan again was suc- 1-800-Contacts entered into an agreement with Opternative and cessful, and attendance was on par with past years. We all know began to offer online “refraction” as a way to bypass a visit to an that the CE component is most relevant to most attendees, but eye care practitioner. An app called “Simple Contacts” also mar- there is much much more. The NDOA Annual Congress is kets to consumers as a way to renew prescriptions in a fraction of staged to keep the “spirit” of organized optometry alive and well: time. Your NDOA is in the process of communicating with the pure and simple, member engagement is vital to survival. ND State Board of Optometry, the ND Medical Association, and Speaking of politics….by the time you read this, we will have a the ND Board of Medicare, to draft language that will hopefully newly elected President of the United States (like him, or her, or be enforceable to address the online eye exam issue. Stay tuned not) as well as a new North Dakota Governor. As I reflect back as we collectively work through the process. on these past 10 months, I can say 2016 was as unpredictable as These are just a few of the major issues your NDOA has been the national election has proved to be. advocating on your behalf. We sincerely hope that your NDOA Some of the challenges from the beginning of the year have been: membership investment is paying off dividends in the end. To- gether, we thrive and survive! Staff Transition: Upon departure of the NDVMA Administration Contract, Tracy Thomas resigned her position as NDOA Admin- In closing, I would like to congratulate the newly elected NDOA istrative Assistant. Tami Helmers was hired part-time and has Board of Directors! I look forward to maintaining the strengths since made the decision that two part-time positions was not con- of strong leadership that your forebears have instilled since in- ducive, therefore I would like to introduce to you Kari Reim, the ception in 1903! NDOA’s new Administrative Assistant. I appreciate Tami’s as- May you and your families have a very “Happy and Blessed” sistance of the past few months, especially preparing for the An- Holiday Season! nual Congress and look forward to Kari’s enthusiasm to grow with the NDOA well into the future. North Dakota Medicaid Management System enrollment and payment issues were very time consuming on providers, as well as NDOA staff as mediators. We continue to communicate with the Department of Human Services on the Classic Optical Con- ICD-10 MATERIALS tract, which may expire or be renewed December 31, 2016. RECOMMENDATION The North Dakota Medicaid Expansion Program, which provides nearly 20,000 childless working adults with health insurance if After the ICD-10 additions in which thousands of back- they meet the 138% of Federal Poverty guidelines, expires Au- logged codes became active in October, the POA gust 1, 2017 and will be addressed during the upcoming Legisla- Electronic Claims Service recommends all offices tive Session in January, 2017. At that time we will continue to purchase the 2017 AOA Codes for Optometry w/ garner inclusion of adult vision services parallel to Traditional Express Mapping Card & AMA CPT book. Medicaid, as other states have. It will be interesting to see if our You can purchase it through the AOA at this website: new Governor will support funding 5% of the cost of Medicaid https://store.aoa.org/ Product/viewproduct/? Expansion. productId=3634571 The “Think About Your Eyes” program for NDOA members,
Northern Sights November / December Page 5 Thank You for supporting your NDOA PAC! This is an important element of optometry’s legislative activity. Your legislators thank you, too!
Kirsten Baesler, Superintendent of Public Instruction: Pam Musland, District 12: “Thank you so much for your dona- “Thank you very much for your generous gift to my campaign. tion to my campaign—it is much appreciated! As a person who I look forward to our continued work together!” has a brother-in-law and sister-in-law who both are optome- trists, I understand the importance of your work and some of Curt Kreun, District 42: “Thank you for your support and do- the challenges you face in your profession. I appreciate the leg- nation. Having been a small business owner for almost 30 years, islative issues you outlined in your letter of support. It will serve I will work to be a voice for common sense business.” as a good base of information if I am elected.” Naomi Muscha, District 24: “Thank you very much for your Dwight Kiefert, District 24: “Robbin and I would like to ex- financial contribution to my re-election campaign. Your support press our gratitude in your support of our re-election effort. is truly appreciated.” Without your donations it would be impossible to conduct a Mike Schatz, District 36: “Thank you for your generous dona- successful run. This election could very well be the most im- tion! I will put it to work!” portant event in our nation’s history, and I pledge to do all I can to preserve the way of life we have come to enjoy in North Da- Don Longmuir, District 2: “Thank you for your contribution to kota for our future generations.” my campaign. It is greatly appreciated. North Dakota faces many challenges but working together we can meet those Dave Monson, District 10: “Thank you for your contribution challenges.” to my re-election campaign. We are in the home stretch in a tough race and any donations are being put to good use.” George Sinner, District 46: “ I wanted to say thank you for helping my re-election campaign. I have worked very hard once Jerry Klein, District 14: “ Thanks a bunch for the contribution again and have had great support from the local people. Thank to my campaign. We are working hard, wrapping up our door-to you again.” -door, and adding to our radio ads. Thanks again! I plan to be back.” Tim Flakoll, District 44: “ Thanks so much for the donation to my senate campaign. Hope your fall is going well!” Scott Meyer, District 18: “Thank you very much for the cam- paign donation! With only 2 weeks left until election, the funds Jim Kasper, District 46: “Thank you for your contribution to will be used for last mailer. I feel confident that District 18 will my re-election campaign. Your help is truly appreciated. Our win a couple of seats for the GOP.” Republican team in District 46 is committed to working hard to be able to elect all 3 of our District 46 Republican candidates. Your support really helps.” WELCOME NEW MEMBERS OF THE NDOA! David Rust, District 2: “Thank you for your recent contribution to Rust for Senate. Greatly appreciated! It should be an interesting session!” Dr. Patrick Williamson, OD David Hogue, Dan Ruby, Larry Bellow, District 38: “Just Pearle Vision wanted to drop a short note and say thank you for the contribution. We appreciate the support.” 3232 13th Avenue South
Dick Anderson, District 6: “Thank you for the donation! It is Fargo, ND 58103 much appreciated!” Phone:701-280-3000 Gary Lee, District 22: “Thank you for the generous support of [email protected] my campaign! It is a pleasure working with your group. I value School: Pacific, 2016 the service you provide to our citizens.”
Northern Sights November / December Page 6
CLASSIFIEDS What is a Prescription Drug Monitoring Program? EQUIPMENT FOR SALE—Used, Good Condition Chair/Stand: one a Marco, the other handicap accessi- ble Reliance
Slit lamps: SL-7D Topcon, Zeiss, portable SL-14Kowa
Two Marco keratometers n an effort to combat the opioid and heroin Iepidemic and to empower medical professionals, includ- Reichert/ Leica phoropters: projectors, BIO's, a wire- less Keeler, wall mounted Proppers ing optometrists who hold a DEA, to prescribe a con- trolled substance and to identify patients struggling with A variety of Volk BIO and SL lenses; addiction, the Legislature passed law last session, to im- Retinomax plement a Prescription Drug Monitoring Program in North Dakota. Humphrey 745i fields analyzer, GDX
Miscellaneous instrumentation The North Dakota State Board of Optometry is responsi- ble for adopting rules, to require licensed optometrists Joe Thorman, OD (retired), Rolla Eye Clinic to participate in the PMPD. Once registered, you will [email protected] 701-212-6328 take a critical first step in accessing valuable clinical in- formation to better care for your patients. You will be able to grant access to delegates employed by you, to check the system on your behalf. LOCUM OPTOMETRIST NEEDED
Looking for a fill-in OD to cover maternity leave in Regardless of the fact that optometrists in North Dakota are only allowed to prescribe one controlled substance, January—February at 40 hrs/wk Tylenol 3, you are and hopefully always will be, part of $9,000 per month the total health care delivery team of providers. Your predecessors worked very hard, in the past, to achieve Possibility for full-time employment after fill-in term has prescriptive authority on your behalf. Who knows, what expired new and improved pharmaceuticals are on the horizon, Dr. Jim Woodmansee that you may want to prescribe for your patients, for Family Eyecare, Grand Forks pain relief? (701) 780-8726 or email: [email protected]
FULL-TIME POSITION AVAILABLE!
Focus Family Eyecare—Fargo.
Contact Dr. Stacey Archibald at
IN SEARCH OF PER DIEM OPTOMETRIST
-1 day/ week, occasional Saturday morning post ops. -Competitive pay and a great staff! -No refractive surgery experience required - will train.
TLC Laser Eye Centers - Fargo. Call 701-293-7945 or email [email protected]
Northern Sights November / December Page 7 “Time Sensitive”
Northern Sights November / December Page 8