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Retinal imagers: can you afford one in your practice?
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Turnaround time, advanced technology, improved patient care and a relatively new current procedural terminology (CPT) code for billing are some of the reasons that more practitioners are using retinal imagers in their practices. However, a system that is useful for patients and financially beneficial for one practice may not be a good investment for another.
How much will you get reimbursed?
Jerome Sherman, OD, spoke to Primary Care Optometry News about the units’ cost-effectiveness for his practice settings. In three different locations he uses two GDx Nerve Fiber Analyzers from Laser Diagnostic Technologies (San Diego), two Retinal Thickness Analyzers (RTAs) from Talia Technology (Englewood, Fla.) and the Heidelberg Retina Tomograph (HRT) from Heidelberg Engineering (Carlsbad, Calif.). In his Manhattan office, he performs about 10 procedures per day with a reimbursement of at least $100 per test.
Rates of reimbursement vary widely depending on location and the type of insurance with which you are dealing, Dr. Sherman said. Some third-party payers do not reimburse at all, considering the procedures as experimental. On the flip side, some insurance companies reimburse more than Medicare, up to $275 per patient. The Medicare reimbursement rate (CPT code 92135) in New York City is $185 per patient, said Dr. Sherman.
J. James Thimons, OD, FAAO, said that anything an imager can do is theoretically covered by HMOs. “There’s a lot of confusion about what is covered and what isn’t,” he said. “Medicare covers nerve fiber layer analysis given the diagnosis, most likely glaucoma. The reimbursement now is about $145 to $150.
“If you’re doing a large volume of photos, the time and money you save by not having to get film processed, returned and put back in the records can be substantial,” Dr. Thimons said. “We’ve estimated that it can take up to 45 minutes per patient.”
“The Medicare reimbursement rate makes the technology very attractive in my mind,” said Dr. Sherman. “Six Medicare patients per week will generate $1,000.” He pointed out that all the units use the same CPT code, so you cannot use more than one instrument on one patient in the same day and expect to be reimbursed for both. He said, for that reason, it may not make sense to own more than one of the units, even though, clinically, they provide different information.
Dr. Sherman explained that practitioners should ask themselves these questions: How many patients do I have who need the test? What is the reimbursement breakdown? How much will the system cost me per month?
Time involved, usefulness
Dr. Sherman said a test with the RTA takes about 15 to 20 minutes and requires dilation; the HRT takes 15 minutes, and the results are better with dilation; the GDx requires no dilation and takes 5 minutes; and the Optical Coherence Tomography (OCT) Scanner from Zeiss Humphrey Systems (Dublin, Calif.) takes 30 minutes and requires dilation.
The RTA is very helpful for patients with thick maculas, as in diabetes, he said, and the OCT gives the best images, but it takes the longest to perform.
The TopSS Topographic Scanning System from Laser Diagnostics Technologies, according to private practitioner John A. McCall Jr., OD, analyzes the optic nerve and other areas of the retina using confocal scanning laser tomography.
“The reason I purchased the TopSS is because it has the ability to give you more than just information on the optic nerve and NFL,” he said. If you have a macular hole, it will measure the diameter and depth of the macular hole. If you have cystoid macular edema, it will measure how much of the macula is swollen, and it gives you a quantitative measurement that you can compare to find out if you’re resolving the problem.”
Dr. Thimons said he uses most of the technologies available in his practice on a regular basis. “From a diagnostic perspective, the HRT has been very successful for us,” he said. “GDx is also a good diagnostic tool for very early glaucoma.”
Adding a GDx to a private practice can be valuable. In his practice, however, Dr. Thimons sees a number of glaucoma patients, often with more advanced disease, so he uses the HRT more.
Buy, acquire or pass?
Dr. Sherman said the GDx Access cannot be purchased. The practitioner pays an acquisition fee and then also pays a per-use fee. The fee is lower the more scans that are performed.
He compared the advantages of purchasing the GDx Nerve Fiber Analyzer vs. “acquiring” the GDx Access. While the price tag may be high for the larger unit, he said, you do not have a company as your partner. It would be better for a practitioner who is doing a lot of scans to purchase instead of acquire the instrument.
Dr. McCall said the key point to remember when evaluating the cost-effectiveness of investing in an imager is that an instrument that will pay for itself is an instrument for which you can get reimbursement that you are not currently receiving.
“Practitioners should ask themselves: Is this a benefit for my patients? Can I pay for this? Is it profitable for my practice? Speaking from my own personal experience, any diagnostic instrument based on new technology — dating back to retinal cameras and B-scans — that has allowed me to do something in my practice that I could not do before, always ends up paying for itself.”
For Your Information:
- Jerome Sherman, OD, a member of the Primary Care Optometry News Editorial Board, can be contacted at the SUNY State College of Optometry, 100 East 24th St., New York, NY 10010; (212) 780-5004; fax: (212) 780-5207; e-mail: jsherman@sunyopt.edu. Dr. Sherman has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
- J. James Thimons, OD, FAAO, is a member of the Primary Care Optometry News Editorial Board and can be reached at Ophthalmic Consultants of Connecticut, 75 Kings Highway Cutoff, Fairfield, CT 06430; (203) 255-6196; fax: (203) 254-1467; e-mail: Jim.Thimons@lzr.com. Dr. Thimons has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
- John A. McCall Jr., OD, is a member of the Primary Care Optometry News Editorial Board and can be reached at 711 E. Goliad, Crockett, TX 75835; (409) 544-3763; fax: (409) 544-7894. Dr. McCall has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.