Frequency of Gonioscopy and Pachymetry on First Visit Glaucoma Patients

Abstract

Purpose: To study the frequency that gonioscopy and pachymetry is done and billed for on first visit glaucoma patients and measure lost revenue.

Methods: The most recent patients for first ophthalmology visits given the diagnosis of glaucoma with an ICD code of 365.xx at the Kresge Eye Institute were used to form a patient list. These patients were seen from May 2013 to Aug 2013. Patients were then organized as being seen by a glaucoma specialist or non-glaucoma specialist. All patients were further identified as seen in a private clinic or resident clinic. 980 right eyes were used in the study using electronic medical records to obtain relevant data. We recorded whether gonioscopy and pachymetry was completed during this first visit. A revenue analysis was done using a percentage of patients on various insurance coverage plans, as well as the reimbursement given by each plan for gonioscopy and pachymetry.

Results: Our results indicate that gonioscopy and pachymetry are under utilized. Among the 980 patients in our study, 17.96% of patients had gonioscopy performed on their initial visit. The specialty training of the ophthalmologist seeing the patient as well as the setting of the initial visit appeared to play a role in whether or not gonioscopy was done. Gonioscopy was performed more often by glaucoma doctors in their private clinics 47.57% than by non-glaucoma doctors in private clinic 5.88% (P-value <0.0001). Gonioscopy was performed even less often by glaucoma doctors in resident clinic 18.75% and by non-glaucoma doctors in resident clinic 8.14% compared to glaucoma doctors in private clinic (P-value <0.0001). Pachymetry was performed more often by glaucoma doctors in their private clinics 67.04% than by non-glaucoma doctors in private clinic 23.74%. Pachymetry was performed even less often by glaucoma doctors in resident clinic 12.5% than by non-glaucoma doctors in resident clinic 14.50%. These differences were statistically significant (P-value <0.0001). Based on insurance types and reimbursement for the Kresge Eye Institute, we estimate lost revenue to be $32,265.40 in these 980 patients during 5/3/13-09/13/13.

Conclusions: Goniscopy and pachymetry are not optimally performed or billed for on first visit glaucoma patients at the Kresge Eye Institute. Practice patterns for glaucoma can be ignored and institutions can lose revenue failing to bill for these procedures.

Keywords: 460 clinical (human) or epidemiologic studies: health care delivery/economics/manpower