Fundus Photos

**milesdavis** · 11-12-2005, 11:22 PM

What are most people charging for fundus photos?
Are you using them for medical necessary only or as an additional service offering it to all pateints as an increased level of care for an aditional fee?

**fjpod** · 11-13-2005, 07:07 AM

Originally Posted by milesdavis

What are most people charging for fundus photos?
Are you using them for medical necessary only or as an additional service offering it to all pateints as an increased level of care for an aditional fee?

Primarily doing photos in medically necessary cases. Most patients, coming into my office anyway, are expecting their visit to be covered by their medical and or optical insurance. So, we get the attitude from the patient that if my insurance won't pay for it, then it's really not necessary.

The fact is, if it is necessary, then medical insurance will cover it. IMHO.

**chip anderson** · 11-13-2005, 08:04 AM

Once upon a time this was done by the local independent optical shop as a public service (no charge). Now it's a way to "boost revenue." Other than a historical record for some specific conditons I don't really see it haveing any other purpose.

I can remember when I would see patient's with detachment seeing 20/80, the doctor sent them to Alice McPherson and they came back seeing 20/30. Then they started sending them to New Orleans and Memphis. They came back seeing 20/80 but praising the doctor's office for how modern it was and how many picutures the doctor took.

Are we sure we are evolving in the right direction?

Chip

How is taking retinal picutures an "increased level of care" on a healthy patient?

**milesdavis** · 11-13-2005, 08:38 AM

There was a recent case where a OD was charged for missing Wet ARMD. He routinely does fundus photos that backed up that the patinet developed after the visit.

**chip anderson** · 11-13-2005, 09:15 AM

Note: This was one case. Note: This was an added protection for the examiner, the patient did not realize any "added service" or "added benefit."

It's a damn revenue builder unless some pathology is present. It might be a benefit if something was suspected and copies sent to some institution with greater expertise, but I doubt this is the case when photos are done as routine exam fodder.

Chip

**milesdavis** · 11-13-2005, 10:19 AM

Wanting to increase revenue is a problem? In today's society where people will sue for spilling hot coffee on themselves. If i can provide and increased level of service and oh yeah "wow" the patient with it seems logical to me.

**Framebender** · 11-13-2005, 11:15 AM

the old polariod fundus camera that flashed as bright as all outdoors. 5 years ago we switched to digital images that are easier to save and to transmit. We don't charge for taking pictures and it is routinely done on all patients.

The Dr is an older doc that also dilates everyone, every year need it or not. That's just his comfort level and now that his practice has grown old with him we see alot more glaucoma and other age related diseases. This is just the standard of care he has set for his patients.

I'm not a Dr, I don't even play one on tv. If my Dr feels that this is what his patients need. Or if this is what Dr needs to feel that he's done the best for his patients, then God bless him. I don't feel the need to judge him.

I don't think that it has hurt the practice. In the long run I think his reputation has been enhanced and that alot of people come to see us because of his thoroughness.

I hope you're all having fun and making money!! :)

**Happylady** · 11-13-2005, 12:11 PM

We offer pictures and visual fields as an option for the patient. There is a sheet of paper that explains the tests and asks if the patient wants it done. The price is clearly marked and it states that optical insurance doesn't cover it.

If the patients have questions we tell them to mark it with a question mark and discuss it with the doctor.

We charge $18.00 for the pictures and $24.00 for visual fields.

**ilanh** · 11-14-2005, 12:08 AM

I am very ambivalent regarding the routine visual fields and fundus photos that are so prevalent in optometric practices. Let me assure you, as a board certified fellowship trained glaucoma specialist, that there is absolutely no reason whatsoever to do a visual field on a normal individual who has normal IOP's and optic nerves. I don't see any justification for it other than the billing. Occasionally the visual field will catch an homonymous hemianopia or some other neurological defect which usually represents an old stroke. I have never seen it detect glaucoma that I wouldn't have detected otherwise. However, I have seen numerous cases in which a "suspicious" field was sent for exhaustive workups which never benefitted anybody. I simply don't feel that they're necessary and would suggest that optometrists stop doing them.

Secondly, I cannot see any justification for routine fundus photos either. I dilate every new patient that I see, every patient with pathology and any patient coming for an annual visit. If the patient is young, is there only for refraction and has big pupils I will use my small pupil BIO to get an adequate look without dilation. Therefore, I can't really justify doing and charging for a fundus photo which will not help me in any way.

I would love to find ways to increase practice revenues but I simply can't bring myself to recommend these to my patients. If there was even a bare iota of evidence that they help in any way I would leap upon it in a moment (I have all the equipment in my office and would use it on everyone if it helped).

**lee1590** · 11-14-2005, 02:30 AM

I am very glad that this topic has been brought up and that there is a board certified physician on this forum who is speaking on this matter.

For the past couple of days I have been trying to find empirical data that supports the efficacy (or usefulness) of fundus photography. I am currently employed in an "independent" optometrist's office that is owned by a large corporation. We charge $19 for a fundus photo that is separate from our basic eye exam. Our doctors are ambivalent about the photos and I have never personally seen them use them in any sort of capacity. One doc even admitted that it was hard to distinguish certain pathologies due to the limited resolution of digital cameras. Yet, the powers to be have set up strict quotas that are to be met irregardless of the patient's condition.

The reasoning given to me for such number padding is that we need a "baseline" of the patient's retina every two years. "We use it for note taking purposes; just like they say a picture is worth a thousand words" , or so I was told. Does this sound at all like a reasonable justification for this procedure?

I would love to be able to show my managing optician/boss that this push to drive up numbers for the sake of increased profit revenue is not beneficial to the patient. Any suggestions???

**npdr** · 06-07-2006, 08:55 PM

Originally Posted by ilanh

I am very ambivalent regarding the routine visual fields and fundus photos that are so prevalent in optometric practices. Let me assure you, as a board certified fellowship trained glaucoma specialist, that there is absolutely no reason whatsoever to do a visual field on a normal individual who has normal IOP's and optic nerves. I don't see any justification for it other than the billing. Occasionally the visual field will catch an homonymous hemianopia or some other neurological defect which usually represents an old stroke. I have never seen it detect glaucoma that I wouldn't have detected otherwise. However, I have seen numerous cases in which a "suspicious" field was sent for exhaustive workups which never benefitted anybody. I simply don't feel that they're necessary and would suggest that optometrists stop doing them.

Secondly, I cannot see any justification for routine fundus photos either. I dilate every new patient that I see, every patient with pathology and any patient coming for an annual visit. If the patient is young, is there only for refraction and has big pupils I will use my small pupil BIO to get an adequate look without dilation. Therefore, I can't really justify doing and charging for a fundus photo which will not help me in any way.

Dear ilanh,

I agree that routine visual fields or photos yield very little. We should be honets with ourselves and say that these routine tests are mainly to be competitive or to increae revenue and isn't yield.

npdr

**William Stacy O.D.** · 03-05-2006, 02:17 PM

Originally Posted by milesdavis

What are most people charging for fundus photos?
Are you using them for medical necessary only or as an additional service offering it to all pateints as an increased level of care for an aditional fee?

As I understand it, we're not supposed to talk fees here, but then I always question authority and proceed with what I think is right. You can see how I handle it by going to http://www.folsomeye.com and can see an example of the Canon system I use. In a nutshell, I charge when I can, but I always do a baseline photo, always.

**beach57** · 06-07-2006, 08:22 PM

I am not an eye care professional, but a patient. I have been troubled by the fact that my former optometrist routinely told each patient that they needed to have a retinal photo done every year at a charge of $55. I have observed this while sitting in the waiting room. Patients (both young and old) have been informed that they MUST have this picture taken. It wasn't even presented as an option. I have never seen a single person say no. I'm sure there was no medical indication to do so in the majority of patients. I've had mine taken 3 years in a row. My teenage daughter just had her second one taken.

Reading these postings has just confirmed what I suspected. That this is being done to increase revenues. I can't believe I was so naive to agree to pay for 5 needless photos at a total cost of $275!! :angry:

**GOS_Queen** · 06-08-2006, 09:43 AM

Originally Posted by beach57

I am not an eye care professional, but a patient. I have been troubled by the fact that my former optometrist routinely told each patient that they needed to have a retinal photo done every year at a charge of $55. I have observed this while sitting in the waiting room. Patients (both young and old) have been informed that they MUST have this picture taken. It wasn't even presented as an option. I have never seen a single person say no. I'm sure there was no medical indication to do so in the majority of patients. I've had mine taken 3 years in a row. My teenage daughter just had her second one taken.

Reading these postings has just confirmed what I suspected. That this is being done to increase revenues. I can't believe I was so naive to agree to pay for 5 needless photos at a total cost of $275!! :angry:

Needless?

I disagree ~ What I would tell patients about optomap in the practice I worked at where it was optional, it that it is a digital record that is a permanent part of your medical file ~ can be transferred with your file to a new office ... and can be tracked and compared thru the years ...

I go to a dental practice that not only takes "regular" xrays but also has a new digital picture device that they use to take a different type of picture.

I think there is "basic" about having the DR look at your eyes for a few minutes, charting notes about what he sees and then moves on compared to being able to exam a picture of your eye from 1-2 years previously to NOW ... side by side to see what if any changes are going on ~

I think technology is a good thing ~

**npdr** · 06-08-2006, 10:51 AM

Originally Posted by GOS_Queen

Needless?

Originally Posted by GOS_Queen

I disagree ~ What I would tell patients about optomap in the practice I worked at where it was optional, it that it is a digital record that is a permanent part of your medical file ~ can be transferred with your file to a new office ... and can be tracked and compared thru the years ... "

Dear GOS_Queen,
Are you posting your rationale because you yourself think that is useful in clinical decision making?