REFRACTIVE 20 EWAP MARCH 2024 Dr. Parkhurst agreed that sizing strategy is extremely important for success with ICLs. “We’ve got some new nomograms we’re working on, with artificial intelligence and machine learning, to use diagnostic scans to predict the ideal size for the ICL,” he said. “One of the most critical things in terms of having success is picking the size right, and it’s nuanced. It’s not easy in the current state without the right diagnostic technology to size the lens properly. Because we’re now confident with the way we’re doing sizing with UBM technology and arc scans, we’re finding that we’re able to go to shallower anterior chamber depths than what we used to be comfortable with.” For example, he said the minimum AC depth before the EVO ICL was 2.8 mm, but now he has even gone to 2.6 mm. “That is one area where we’re finding that more patients qualify, whereas we would have turned them away in the past,” he said. Dr. Parkhurst added that he wouldn’t recommend surgeons new to the EVO ICL going this low in their first handful of cases until they are confident in their sizing strategy. EWAP Editors’ note: Dr. Hura practices at Maloney-Shamie Vision Institute, Los Angeles, California, and has interests with STAAR Surgical. Dr. Lin is Associate Professor of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and declared no relevant financial interests. Dr. Parkhurst practices at Parkhurst NuVision, San Antonio, Texas, and has interests with STAAR Surgical. External image in slit lamp showing ICL vault. Source: Alexandra Wiechmann, OD physical findings in the medical record indicating that the patient’s impairment of visual function is believed not to be correctable with a tolerable change in glasses or contact lenses. This attestation is not present in the documentation. Also per LCD, documentation must include a statement that a reasonable expectation exists that lens surgery will significantly improve both the visual and functional status of the patient. This is not supported in documentation submitted.” Mr. Christensen said in response to these findings, the physicians were given a standardized documentation protocol for cataract surgery to follow that would coincide with their exam findings. He also said that in partnership with University Medical Billing, a percentage of their office visits are reviewed for accuracy. Based on the prospective review, “changes are made to bill the appropriate level of service for the work that has been documented,” he said. “Our coding team collaborates effectively with our surgeons to ensure cases are coded appropriately. In the event that a mistake is found, communication is sent to the provider for clarification and correction. Recently, a laterality error was Learning...errors- from page 15 identified in a section of an op note. The mistake was identified, the provider emailed, and an addendum created to correct the mistake prior to the release of the claim.” Mr. Christensen said that their EHR is regularly updated, which helps facilitate accurate and timely documentation. In general, “careful attention to the accuracy of documentation is critical to the safety/ treatment of the patient and success of the business,” Mr. Christensen said. Pro for paper Dr. Zhu said she likes having everything in one place and being able to spend more time “face time” with the patient rather than on a computer. “I can review a chart and see the OCT, topography, biometry simultaneously. It’s also easy for me to handwrite notes in the chart to do calculations or highlight important findings when making my final IOL selection. It’s a little cumbersome when everything is electronic and you have to open different windows to do those same evaluations,” she said. EWAP Editors’ note: Dr. Bartlett is Associate Clinical Professor of Ophthalmology, Stein Eye Institute, UCLA David Geffen School of Medicine, Los Angeles, California. Dr. Christensen is Associate Director of Accounting and Finance, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah. Dr. Zhu is Medical Director and Partner, NVISION Eye Centers, Rowland Heights, California. None declared any relevant financial interests.
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