Retinal Photos

**Optician Magician** · 03-12-2009, 05:18 PM

Does anyone work in an office that does retinal photography? We just purchased the camera for our office and I was wondering how to promote it to the patients before the actual exam. I was wondering what worked for other offices.

Thank you!

**peregrinerose** · 03-12-2009, 05:23 PM

Originally Posted by Optician Magician

Does anyone work in an office that does retinal photography? We just purchased the camera for our office and I was wondering how to promote it to the patients before the actual exam. I was wondering what worked for other offices.

Thank you!

We've had one almost a year now and love it. I have a form that patients sign, I can probably scan and email to you if you want to give me your email address. Probably 75% opt for the screening photo ($20 fee), another 15% want to talk to me about it first, the rest say no. Some of them (like ARMD patients) are billable to medical because there's a lot more that goes on with a med photo (more interpretation, more diagnostic data, more monitoring of disease process, often a letter to another doc or PCP). If you don't have a printer yet, I highly recommend that too. I give a copy of photos to all my patients, and it's turned out to be good PR. I also have my own little database of nasty disease photos that I pull up when appropriate, great for putting a bit of fear in non-compliant DM patients.

**Optician Magician** · 03-12-2009, 05:28 PM

Thank you for your quick response! Do you have a certain "script" that you use when discussing it with patients? I will pm you with my email address, thanks!

**chip anderson** · 03-12-2009, 06:36 PM

I'd comment on useing these things only when something is found during exam that looks suspicious and needs photographic recording, instead of selling a "medical exam or treatment." But I have the O.D.'s too stirred up already today.

Chip

**fjpod** · 03-12-2009, 07:42 PM

Originally Posted by chip anderson

I'd comment on useing these things only when something is found during exam that looks suspicious and needs photographic recording, instead of selling a "medical exam or treatment." But I have the O.D.'s too stirred up already today.

Chip

Fundus photos often reveal retinal pathology that you cannot see with an ophthalmoscope. So Dr. Chip, what do you think I should do? Use the best diagnostic instrument available or...do what you think is best? It's not that I have anything against you, Chip, it's just the statements you come up with.

**chip anderson** · 03-12-2009, 08:44 PM

Appearently they aren't needed until you buy one and have to pay for it. Then the machine must pay for itself. Prior to buying the machine you were perhaps happy to take chances on all this unobserved, undetected pathology?

Sure

**Sissy63** · 03-12-2009, 10:00 PM

hI THERE

OUR OFFICE FIRST TALKS TO THE PATIENTS ABOUT IT ON THE PHONE WHEN THEY ARE MAKING THIER APPOINMENT MOST COME PREPARED FOR THE TEST AND RATHER HAVE THAT DONE THAN TO BE DILATED.
I MEANT TO SAY THAT IS ON THE OPTOMAP, NOT ON THE CAMERA .THE DRS EVEN IF THEY SEE SOMETHING THEY WILL GO AHEAD AND DILATE BUT, WE ALWAYS TRY TO PREPARE THE PATIENT FOR THE DILATION.

**OHPNTZ** · 03-12-2009, 10:08 PM

I'm not a fan of using one as a "screening" device. It goes along the same argument for/against the "Optomap".

If you take a good enough look dilated, you will use it quite often for photodocumenting lesions, nerves, etc...and it will pay for itself. Make sure to bill properly for its use.

Look to see if the camera is able (or you're able to convert it...)to take anterior segment photos also.

Send copies of photos with diabetic retinopathy to all primary care physicians with included reports...a good practice builder.

**MarcE** · 03-12-2009, 10:16 PM

Originally Posted by chip anderson

I'd comment on useing these things only when something is found during exam that looks suspicious and needs photographic recording, instead of selling a "medical exam or treatment." But I have the O.D.'s too stirred up already today.

Chip

Good idea. Don't say anything then you can secretly feel good about yourself for listening to your mother when she said "Chip, if you don't have anything good to say, don't say anything at all". After all, it's the Christian thing to do - Judge not and all.

**OHPNTZ** · 03-12-2009, 10:26 PM

Originally Posted by Sissy63

hI THERE

OUR OFFICE FIRST TALKS TO THE PATIENTS ABOUT IT ON THE PHONE WHEN THEY ARE MAKING THIER APPOINMENT MOST COME PREPARED FOR THE TEST AND RATHER HAVE THAT DONE THAN TO BE DILATED.

That scares me...especially for tears or retinal detachments...I wouldn't advise doing this...

**HarryChiling** · 03-12-2009, 10:36 PM

Originally Posted by OHPNTZ

That scares me...especially for tears or retinal detachments...I wouldn't advise doing this...

Our office does something similar, we have recommend that if the patient skips dilation they get the photo's, but the caveat is that it is not a replacement for dilation and if the doctor sees something questionable the must be dilated anyway. Then we recommend that the next visit they absolutely get dilated.

**OHPNTZ** · 03-12-2009, 10:42 PM

Harry,

I believe that is a poor way to promote photos. To rationalize...if you can get quality undilated photos, you can just as well evlaulate minimally the posterior pole (anything withn the arcades) with a fundus lens.

How does the doctor evauate the retina at your office undilated???

**Uncle Double** · 03-12-2009, 11:22 PM

We've had a camera for 10 years, and now have an optomap. Most of our patients leave work to come in, most won't let us dilate their eyes (even if their insurance covers dilation and not retinal photos or optomap). We offer annual optomaps for patients without a Hx of pathology between dilations (3-5 years), and annually for our diabetic patients who refuse dilation. I have to admit, I've never seen anything with my BIO that wasn't also picked up by the optomap, nor have I missed anything. Even though it has been said again and again that it doesn't take the place of dilating, I haven't seen any difference. I have, however, seen things with the optomap and dilation that I did not see with a retinal photo. I do prefer the image of the posterior pole with the retinal camera to the image of the optomap. Patients like to see their photos/images and it is good PR, but never should it be sold to someone (heck, I won't even let the optician sell lens options to patients, but they do have to discuss them, and tell the patients which ones they don't need and why).

If you want to discuss it with them, show them a photo of a normal eye and one that isn't. Some will choose to have it done, some won't. If you believe it's a good thing, you will be able to recover your costs+ a little, if not, you'll probably need to upgrade the camera about the time it's paid off. You won't get rich off it, no matter what anyone says.

**OHPNTZ** · 03-13-2009, 12:23 AM

Uncle,

We could debate this heavily, and I think you would agree with me on this one...

The optomap is COMPLETELY pointless on an undilated diabetic. The goal of diabetic fundus examination is to determine if treatment is needed or not, and also to determine the frequency of re-examination.

You cannot determine if CSME is present or not with an Optomap. You will have difficulty finding IRMA, with the poor resolution of the macula area. The list goes on.

For the money that you have to pay OPTOS, it is not worth it...

**eryn** · 03-13-2009, 08:41 AM

We take retinal photos in our office. There is a full page explanation in our welcome to the office forms of the benefits of the photo and the charge. We generally don't go over it on the phone, just when they are in the office and have questions. Last week the OD was able to identify a tumor in a small child. I believe in letting the patients decide, and have no objections to this being an add on service.

**Optician Magician** · 03-13-2009, 06:44 PM

Thank you all for your responses! We are not billing ANY insurance so we don't have that to deal with, and pts are told that it doesn't take the place of a dilated exam, and that the photos allow documentation of problems and also allows us to track any changes year to year. I leave it up to the pt. and the doc to discuss the need for the photos, but pts do ask if I would recommend that they do it and question what it is good for. I just wanted to find out if anyone had a simple, easy to understand, explanation for photos that they use in the office. My front office associates are non-optical, but they still tend to get lots of questions, so this would also help them.
:)

**OHPNTZ** · 03-13-2009, 08:58 PM

You should be billing insurance, especially for medical diagnosis. Photodocumentating cupping in glaucoma suspects, ARMD, etc.

**peregrinerose** · 03-14-2009, 08:52 AM

Our patients get a DRI form to read and sign as part of the pre-exam paperwork. It spells out why it's recommended, that some photos are medically needed and will be billed to medical insurance, and what the charge of a screening photo is (lower than medical due to MUCH less time in interpretation, reports to other doctors, etc)

I like one baseline photo in all patients, not one a year, or even every two... ONE baseline. There's no point in doing more than that. It gives me a great way to pick up 'change with time'... particularly in optic nerve disease and vascular disease, detecting change is far easier with a photo than with numbers in a chart, and improves ability to pick up problems more quickly, which is better for the patient.

Patient who get photos get a copy of their pic, plus I give them a brief anatomy lesson on their own retina, so they understand WHY it's imprortant. Some patients, the ones that show interest, I have a library of oc disease photos that I've made over the last year of having a camera, so I can pull up obvious disease.... end stage glaucoma, several stages of DM retinal disease, etc, and they get a better idea of what as a doc, I'm looking for.

Educated patients make better decisions than uneducated ones, so the extra exam time is probably a good thing. Even patients that opt out of DRI, I pull up my own retinal photo and give a quick anatomy lesson.

**HarryChiling** · 03-14-2009, 11:12 AM

Originally Posted by OHPNTZ

Harry,

I believe that is a poor way to promote photos. To rationalize...if you can get quality undilated photos, you can just as well evlaulate minimally the posterior pole (anything withn the arcades) with a fundus lens.

How does the doctor evauate the retina at your office undilated???

The doctor still looks undilated but the photo's are more for documentation that nothing was evident. Photo's aren't really good for anything other than documentation and even then it's a two demensional representation for what is really there. The reality is that the patients were opting to skip dilation before, same as now except we make a little extra. Keep in mind your a doctor that "is looking out for the patients best interest" and I'm the optician jugling between the "doctors best interest, patients best interest, and minding the store" if you could give me a HCPCS code to bill for the tight rope I have to walk then I'm all ears otherwise as a doctor a majority of the time your missing 2/3rds of the picture. (get it picture) Oh by the way my code would need to end with a 5 for complexity. :)

**sharonm516** · 03-14-2009, 12:28 PM

Originally Posted by OHPNTZ

That scares me...especially for tears or retinal detachments...I wouldn't advise doing this...

I agree....

**fjpod** · 03-14-2009, 12:31 PM

Originally Posted by chip anderson

Appearently they aren't needed until you buy one and have to pay for it. Then the machine must pay for itself. Prior to buying the machine you were perhaps happy to take chances on all this unobserved, undetected pathology?

Sure

I dunno, Chip...Is that like when you buy new frame inventory, and you need to sell it, so you charge money for it?

**HarryChiling** · 03-14-2009, 02:16 PM

Originally Posted by fjpod

I dunno, Chip...Is that like when you buy new frame inventory, and you need to sell it, so you charge money for it?

I could see where your going with that and it might be vaild to a degree, but keep in mind like many of your peers have said before we are in retail and you are psuedo medical, so you have a responsibility to do, "what's right for the patient", but with that said the equipment wouldn't have been purchased if it wasn't a good tool to offer your patients so it a case of which came first the chiken or the egg. I think it's a luxury to have a retinal camera in the office since data gained from a retinal camera could be obtained from actually looking with the naked eye, although it does offer a way to see subtle changes over time that could be missed without. Is it absolutely necessary, NO does it make money and offer a good revenue stream, YES otherwise we wouldn't have one in the office.

**HarryChiling** · 03-14-2009, 02:23 PM

I think it may be coming across as something to do in lieu of dilation, when I would think of it as more of a thing to do if dilations refused. It's not necessarily one or the other, but if you refuse dilation we highyl recommend retinal photo's on this visit.

**sharpstick777** · 03-14-2009, 03:43 PM

Originally Posted by fjpod

Fundus photos often reveal retinal pathology that you cannot see with an ophthalmoscope. So Dr. Chip, what do you think I should do? Use the best diagnostic instrument available or...do what you think is best? It's not that I have anything against you, Chip, it's just the statements you come up with.

Fjpod,
I think Chip's answer is based on what the insurance companies would prefer people do. Many offices try to comply with insurance company wishes. If its done before the patient is seen by the Dr., many insurances consider that a screening tool and not diagnostically billable.

Sharpstick