Hi i had a comprehensive eye exam by an ophthalmologist and got the
invoice from medicare. i looked at the procedure code that was billed
and was curious about it so i went to the medicare website to look it
up. now for 92004 there were 3 different fees. why is that? is
limiting charge amount the highest my doctor can put on the insurance
claim, or does he just file the highest fee for participating amt?
just wondering……
sill
I’m not sure why there are 3 different fees for the same code. Can you post
a link to that??
Your doctor can charge whatever he wants. If he wants to charge a million
dollars, he can.
But the medicare will only pay him the limiting charge amount (less any
deductables or copays)
So if the limiting charge amount is $85.00 he will get $85.00 whether he
submits a bill for $100 or for $100000000.
"sill" <si…@yahoo.com> wrote in message
news:8jtur05jgsc9nrc6f0abamfpj67pjrfm03@4ax.com…
- Hide quoted text — Show quoted text -
> Hi i had a comprehensive eye exam by an ophthalmologist and got the
> invoice from medicare. i looked at the procedure code that was billed
> and was curious about it so i went to the medicare website to look it
> up. now for 92004 there were 3 different fees. why is that? is
> limiting charge amount the highest my doctor can put on the insurance
> claim, or does he just file the highest fee for participating amt?
> just wondering……
> sill
Thanks Mike…. I didn’t think this was ‘new’ research as the article
suggested… I thought it was already established that RGP lenses are better
for myopia progression. Anyway, this article:
http://www.siliconehydrogels.org/editorials/index.asp raises some
interesting points on the subject, suggesting that silicone hydrogels may
even result in a reduction in myopia… I’m sure further research is needed
yet, before we can really say this to be the case.
Dom
"Mike Tyner" <mty…@mindspring.com> wrote in message
news:KOJvd.3933$2J2.2321@newsread2.news.atl.earthlink.net…
- Hide quoted text — Show quoted text -
> Nearsighted Children May Benefit from Rigid Contact Lenses
> New research suggests that rigid gas permeable contact lenses may help
slow
> the progression of nearsightedness, or myopia, in young children.
> Newswise – New research suggests that rigid gas permeable contact lenses
may
> help slow the progression of nearsightedness, or myopia, in young
children.
> At the end of a three-year study of more than a hundred 8- to 11-year
olds,
> researchers determined that wearing rigid gas permeable (RGP) contact
lenses
> slowed the progression of myopia by nearly 30 percent, compared to soft
> contact lens wear.
> Only recently did researchers find that young children could handle the
> responsibility of wearing contact lenses.
> The corneas of the rigid contact lens wearers did not change as much as
> those of the soft contact lens wearers. This difference, which is not
> thought to be a permanent change, explains part of the difference between
> the RGP and soft contact lens wearers, said Jeffrey Walline, the study’s
> lead author and an adjunct assistant professor of optometry at Ohio State
> University.
> He and his colleagues caution that the RGP lenses won’t stop myopia in its
> tracks, and also that the effects of these lenses probably aren’t
permanent.
> But the researchers also say that RGP lenses could be a good option for
> nearsighted children who can adapt to wearing them.
> "Severe myopia, which is fairly rare, can lead to a detached retina and
> permanent vision loss or glaucoma," Walline said. "Theoretically, wearing
> RGP contact lenses could lessen the severity of myopia, and likewise the
> chances of developing one of these problems.
> "But it’s also a matter of convenience – keeping myopia’s progression in
> check may mean that a child can see his bedside clock, or walk to the
> bathroom in the middle of the night without having to depend on glasses."
> The study appears in the December 2004 issue of the journal Archives of
> Ophthalmology.
> While myopia can develop at any age, it most often begins during
childhood,
> around ages 6 to 8. Progression typically slows by the mid-teens.
> The researchers evaluated 116 children who participated in the Contact
Lens
> and Myopia Progression (CLAMP) Study at Ohio State. All children were
given
> about two months to adapt to wearing the rigid contact lenses before the
> study officially began.
> "It takes most children about two weeks to get used to this type of
contact
> lens," Walline said. "We wanted to make sure the children could wear the
> rigid lenses for the long-term."
> At the end of the two-month initiation period, children were randomly
> assigned to wear RGP contact lenses or two-week disposable soft contact
> lenses. Children returned to the optometry clinic each year for three
years
> for annual vision checkups.
> A nearsighted eye is typically longer than a normal eye, which results in
> blurred vision when looking at distant objects.
> "To have a permanent effect, contact lenses would ideally slow the growth
of
> the eyeball," Walline said. "The RGP contact lenses did not do that.
> However, they did maintain the shape of the cornea, whereas the cornea of
> the soft contact lens wearers became more curved. This increased corneal
> curve resulted in more myopia in the group that wore soft contact lenses."
> The children in both groups wore their lenses an average of 70 hours a
week.
> The researchers aren’t sure how many hours a day a child would have to
wear
> RGP lenses in order to slow the progression of nearsightedness.
> "Rigid contact lenses may offer visual and eye health benefits that many
> soft contact lenses don’t," Walline said. "These harder lenses allow more
> oxygen to reach the cornea than do most soft contact lenses, and they do a
> better job of correcting astigmatism.
> "These factors, in addition to the modest myopia control, should be
weighed
> against the initial discomfort that sometimes goes along with RGP lens
wear
> when deciding what a child should use to correct his vision problems."
> The current study also suggests that about four out of five children can
> adapt to wearing RGP lenses, which cost about $160 a year, Walline said.
For
> comparison, disposable contact lenses – like the kind used in this study –
> cost about $260 a year.
> Walline conducted the CLAMP study with Ohio State optometry colleagues
Lisa
> Jones, Donald Mutti and Karla Zadnik, the Glenn A. Fry professor of
> optometry.
> The CLAMP Study received funding from the National Eye Institute; Menicon
> Co, Ltd, CIBA Vision Corporation, and SOLA Optical – all contact lens
> manufacturers; and an American Optometric Foundation William C. Ezell
> Fellowship. The authors have no relevant financial interest in the
sponsors
> of the study.
"Dom" <NOmoadsls…@tpg.nospam.com.au> wrote in
news:41bfe31c$1@dnews.tpgi.com.au:
> Thanks Mike…. I didn’t think this was ‘new’ research as the article
> suggested… I thought it was already established that RGP lenses are
> better for myopia progression. Anyway, this article:
> http://www.siliconehydrogels.org/editorials/index.asp raises some
> interesting points on the subject, suggesting that silicone hydrogels
> may even result in a reduction in myopia… I’m sure further research
> is needed yet, before we can really say this to be the case.
> Dom
Several points: Soft lens wear is associated with corneal steepening that
is thought to be hypoxia related. Because silicone-hydrogels do not
contribute to hypoxia, the cornea does not steepen. Also, si-hydrogels may
create corneal flattening in some individuals. Neither of these effects
has anything to do with axial myopia.
Similarly, the RGP study does not say that RGP lenses lead to changes in
axial length. It only concluded that RGP lenses do not lead to corneal
steepening in the way that soft lenses can.
However, I wouldn’t be surprised if we didn’t some research published in
the future about the effect of RGP lenses on axial length via a reduction
in some higher order aberrations.
DrG
- Hide quoted text — Show quoted text -
> "Mike Tyner" <mty…@mindspring.com> wrote in message
> news:KOJvd.3933$2J2.2321@newsread2.news.atl.earthlink.net…
>> Nearsighted Children May Benefit from Rigid Contact Lenses
>> New research suggests that rigid gas permeable contact lenses may
>> help
> slow
>> the progression of nearsightedness, or myopia, in young children.
>> Newswise – New research suggests that rigid gas permeable contact
>> lenses
> may
>> help slow the progression of nearsightedness, or myopia, in young
> children.
>> At the end of a three-year study of more than a hundred 8- to 11-year
> olds,
>> researchers determined that wearing rigid gas permeable (RGP) contact
> lenses
>> slowed the progression of myopia by nearly 30 percent, compared to
>> soft contact lens wear.
>> Only recently did researchers find that young children could handle
>> the responsibility of wearing contact lenses.
>> The corneas of the rigid contact lens wearers did not change as much
>> as those of the soft contact lens wearers. This difference, which is
>> not thought to be a permanent change, explains part of the difference
>> between the RGP and soft contact lens wearers, said Jeffrey Walline,
>> the study’s lead author and an adjunct assistant professor of
>> optometry at Ohio State University.
>> He and his colleagues caution that the RGP lenses won’t stop myopia
>> in its tracks, and also that the effects of these lenses probably
>> aren’t
> permanent.
>> But the researchers also say that RGP lenses could be a good option
>> for nearsighted children who can adapt to wearing them.
>> "Severe myopia, which is fairly rare, can lead to a detached retina
>> and permanent vision loss or glaucoma," Walline said. "Theoretically,
>> wearing RGP contact lenses could lessen the severity of myopia, and
>> likewise the chances of developing one of these problems.
>> "But it’s also a matter of convenience – keeping myopia’s progression
>> in check may mean that a child can see his bedside clock, or walk to
>> the bathroom in the middle of the night without having to depend on
>> glasses."
>> The study appears in the December 2004 issue of the journal Archives
>> of Ophthalmology.
>> While myopia can develop at any age, it most often begins during
> childhood,
>> around ages 6 to 8. Progression typically slows by the mid-teens.
>> The researchers evaluated 116 children who participated in the
>> Contact
> Lens
>> and Myopia Progression (CLAMP) Study at Ohio State. All children were
> given
>> about two months to adapt to wearing the rigid contact lenses before
>> the study officially began.
>> "It takes most children about two weeks to get used to this type of
> contact
>> lens," Walline said. "We wanted to make sure the children could wear
>> the rigid lenses for the long-term."
>> At the end of the two-month initiation period, children were randomly
>> assigned to wear RGP contact lenses or two-week disposable soft
>> contact lenses. Children returned to the optometry clinic each year
>> for three
> years
>> for annual vision checkups.
>> A nearsighted eye is typically longer than a normal eye, which
>> results in blurred vision when looking at distant objects.
>> "To have a permanent effect, contact lenses would ideally slow the
>> growth
> of
>> the eyeball," Walline said. "The RGP contact lenses did not do that.
>> However, they did maintain the shape of the cornea, whereas the
>> cornea of the soft contact lens wearers became more curved. This
>> increased corneal curve resulted in more myopia in the group that
>> wore soft contact lenses."
>> The children in both groups wore their lenses an average of 70 hours
>> a
> week.
>> The researchers aren’t sure how many hours a day a child would have
>> to
> wear
>> RGP lenses in order to slow the progression of nearsightedness.
>> "Rigid contact lenses may offer visual and eye health benefits that
>> many soft contact lenses don’t," Walline said. "These harder lenses
>> allow more oxygen to reach the cornea than do most soft contact
>> lenses, and they do a better job of correcting astigmatism.
>> "These factors, in addition to the modest myopia control, should be
> weighed
>> against the initial discomfort that sometimes goes along with RGP
>> lens
> wear
>> when deciding what a child should use to correct his vision
>> problems."
>> The current study also suggests that about four out of five children
>> can adapt to wearing RGP lenses, which cost about $160 a year,
>> Walline said.
> For
>> comparison, disposable contact lenses – like the kind used in this
>> study – cost about $260 a year.
>> Walline conducted the CLAMP study with Ohio State optometry
>> colleagues
> Lisa
>> Jones, Donald Mutti and Karla Zadnik, the Glenn A. Fry professor of
>> optometry.
>> The CLAMP Study received funding from the National Eye Institute;
>> Menicon Co, Ltd, CIBA Vision Corporation, and SOLA Optical – all
>> contact lens manufacturers; and an American Optometric Foundation
>> William C. Ezell Fellowship. The authors have no relevant financial
>> interest in the
> sponsors
>> of the study.
"Mike Tyner" <mty…@mindspring.com> schreef in bericht
news:KOJvd.3933$2J2.2321@newsread2.news.atl.earthlink.net…
> Nearsighted Children May Benefit from Rigid Contact Lenses
> New research suggests that rigid gas permeable contact lenses may help
> slow the progression of nearsightedness, or myopia, in young children.
> Newswise – New research suggests that rigid gas permeable contact lenses
> may help slow the progression of nearsightedness, or myopia, in young
> children.
> At the end of a three-year study of more than a hundred 8- to 11-year
> olds, researchers determined that wearing rigid gas permeable (RGP)
> contact lenses slowed the progression of myopia by nearly 30 percent,
> compared to soft contact lens wear.
This study should be of more value if a third group of none wearers had been
followed.
Just a thought.
–
Jan (normally Dutch spoken)
In article <KOJvd.3933$2J2.2…@newsread2.news.atl.earthlink.net>, "Mike
Tyner" <mty…@mindspring.com> wrote:
> Nearsighted Children May Benefit from Rigid Contact Lenses
> Only recently did researchers find that young children could handle the
> responsibility of wearing contact lenses.
I don’t like this article. They put contact lenses in the eyes of little
babies.
> "Severe myopia, which is fairly rare, can lead to a detached retina and
> permanent vision loss or glaucoma," Walline said. "Theoretically, wearing
> RGP contact lenses could lessen the severity of myopia, and likewise the
> chances of developing one of these problems.
Sounds like "Otis Brown" logic to me. Someone finds a correlation between
A and B, and therefore concludes that A causes B. However, in many cases,
it could be equally argued that B causes A. That isn’t the case here,
since the myopia generally precedes the other problems. Even so, this is
Bad Science. First you need a theory, and then you need a mechanism.
Without showing *how* A can cause B, you have no theory, just a
correlation. After you develop a theory with a mechanism, you can use
correlation to prove or disprove your theory. Without a mechanism, you
run the grave risk of someone coming along with factor X, with a mechanism
to show how X can cause A, and X can cause B, and a correlation that
proves both.
Otis has proven a correlation between putting lenses on animals, and a
change in refraction. However, he has no mechanism, and thus he has no
theory. Furthermore, the ODs on this group have shown mechanisms to
disprove his theory, and explanations as to how his "proof" doesn’t apply
to the uses he wishes for his theory.
As a counter-example to the original post, take myself. I was a high
myope, and have been treated for high IOP and retinal detachment. I had
cataract surgery in both eyes, and now am no longer myopic. Thus, I have
no further risk of RD or glaucoma, correct? WRONG! I am right now being
treated for high IOP (one drop in each eye every night). How could this
be?
Many years ago I was a student at this place (Sonoma State University,
where I still work). I supplemented our meager family income by working
in a student computer lab. We had a very fast and powerful computer for
academic (student and faculty) use, located in Southern California, and
used by all 19 campuses. Nowadays, phone modems with a speed of 56,000
baud are considered almost too slow for most people. Our connections to
this powerful computer back then were 300 baud, more than 150 times
slower! We had two hardcopy terminals, which took several minutes to
print out a page of output. There were a group of students doing a
research project. They were using this computer with a sophisticated
statistical package to analyze their data. They spent hours every day
printing statistics, with graphs. I didn’t really understand, since
statistics usually summarize the data, but they didn’t have any questions
of me so I didn’t know really what they were doing, other than using up a
lot of paper. One day the students weren’t there, but the faculty advisor
for the project came into the lab. He asked me what I knew about their
project, and what I knew about statistics. I replied that I didn’t know
what they were doing, but that I had taken a couple of college classes in
statistics. He explained that their work involved 20 variables, and that
they were running correlation statistics on every single pair of
variables! They had no theories, and no mechanisms to explain
causations. The professor didn’t have much hair, but he wanted to tear
out the little he had. He had tried to explain to them why they were
doing Bad Science (he was a scientist, a geologist) but they wouldn’t hear
him. They were happy that they had found about 5% correlations. The
professor looked at their statistics, and they were running the standard
95% confidence level. They refused to understand that even if their data
was totally random, that at a 95% confidence level they will find 5%
correlations.
> "But it’s also a matter of convenience – keeping myopia’s progression in
> check may mean that a child can see his bedside clock, or walk to the
> bathroom in the middle of the night without having to depend on glasses."
This certainly makes sense to me.
> A nearsighted eye is typically longer than a normal eye, which results in
> blurred vision when looking at distant objects.
Ahah! Here we may have found our factor X. I have read both on this
group and elsewhere, theories about how an abnormally long eye may cause
both severe myopia and retinal detachments.
> The current study also suggests that about four out of five children can
> adapt to wearing RGP lenses, which cost about $160 a year, Walline said. For
> comparison, disposable contact lenses – like the kind used in this study –
> cost about $260 a year.
I wonder if most soft contact wearers know this. I certainly didn’t.
–
Dan Abel
Sonoma State University
AIS
da…@sonic.net
da…@sonic.net (Dan Abel) wrote in
news:dabel-1512041259470001@ssu-64en129.sonoma.edu:
> Only recently did researchers find that young children could handle
> the
>> responsibility of wearing contact lenses.
> I don’t like this article. They put contact lenses in the eyes of
> little babies.
Age 8-11 years, actually, with informed consent provided by parents, the
study followed the Declaration of Helsinki requirements, and approved by
the relevant institutional review board.
>> "Severe myopia, which is fairly rare, can lead to a detached retina
>> and permanent vision loss or glaucoma," Walline said. "Theoretically,
>> wearing RGP contact lenses could lessen the severity of myopia, and
>> likewise the chances of developing one of these problems.
> Sounds like "Otis Brown" logic to me.
Well, they do have data that they submitted for review, and published it,
thus opening it to criticism of the ophthalmological community. Further,
the treatment group was masked from the assessor.
> Someone finds a correlation
> between A and B, and therefore concludes that A causes B. However, in
> many cases, it could be equally argued that B causes A. That isn’t
> the case here, since the myopia generally precedes the other problems.
> Even so, this is Bad Science.
After finding many differences between press releases and published work,
I’ve learned that you need to go to the paper before making conclusions
or forming criticism. This press release, in particular, seems much
rosier than the conclusions of the paper. Investigators don’t get much
say about what appears in the lay press, nor do scientific reviewers.
The abstract, in fact, ends with "The results of the
study provide information for eye care practitioners to share
with their patients, but they do not indicate that RGPs
should be prescribed primarily for myopia control." You certainly
wouldn’t get that out of this press release
> First you need a theory, and then you
> need a mechanism. Without showing *how* A can cause B, you have no
> theory, just a correlation. After you develop a theory with a
> mechanism, you can use correlation to prove or disprove your theory.
> Without a mechanism, you run the grave risk of someone coming along
> with factor X, with a mechanism to show how X can cause A, and X can
> cause B, and a correlation that proves both.
I think if you read the paper, you’d be somewhat more satisfied. In fact,
my interpretation is that these authors, unlike those of some previous
studies, don’t hold out much hope for the use of RGPs being used
primarily for myopia control. They also do not believe that any change
in myopic progression will be permanent. The hypothesis put forth is one
of corneal shaping.
Scott
In article <Xns95C0AE9272E7scottseidmanminds…@130.133.1.4>, Scott
Seidman <namdiestt…@mindspring.com> wrote:
> da…@sonic.net (Dan Abel) wrote in
> news:dabel-1512041259470001@ssu-64en129.sonoma.edu:
> > Only recently did researchers find that young children could handle
> > the
> >> responsibility of wearing contact lenses.
> > I don’t like this article. They put contact lenses in the eyes of
> > little babies.
> Age 8-11 years, actually, with informed consent provided by parents, the
> study followed the Declaration of Helsinki requirements, and approved by
> the relevant institutional review board.
I couldn’t figure out what the heck you were posting about, even reading
several times. Then I read what I wrote several times, and realized that
I had worded it very badly. What I didn’t like about this part of the
press release was they were saying that it was just discovered that you
can use contacts in kids. My response was that doctors have been putting
contacts in little babies for years. This is *not* a recent discovery, as
far as I know.
> >> "Severe myopia, which is fairly rare, can lead to a detached retina
> >> and permanent vision loss or glaucoma," Walline said. "Theoretically,
> >> wearing RGP contact lenses could lessen the severity of myopia, and
> >> likewise the chances of developing one of these problems.
> > Sounds like "Otis Brown" logic to me.
> Well, they do have data that they submitted for review, and published it,
> thus opening it to criticism of the ophthalmological community. Further,
> the treatment group was masked from the assessor.
I don’t have a problem with the study (not that I’ve read it), but with
the statement that a reduction in myopia might lead to a reduction in
glaucoma and retinal detachment.
> > Someone finds a correlation
> > between A and B, and therefore concludes that A causes B. However, in
> > many cases, it could be equally argued that B causes A. That isn’t
> > the case here, since the myopia generally precedes the other problems.
> > Even so, this is Bad Science.
> After finding many differences between press releases and published work,
> I’ve learned that you need to go to the paper before making conclusions
> or forming criticism. This press release, in particular, seems much
> rosier than the conclusions of the paper. Investigators don’t get much
> say about what appears in the lay press, nor do scientific reviewers.
In fairness to myself, I have not read the study, and my criticisms apply
to the press release posted to this group.
> I think if you read the paper, you’d be somewhat more satisfied.
Could be, but I’m no technical person about these things. I’m just
criticizing what was posted to this group, in the hope that someone would
either agree or set me straight.
–
Dan Abel
Sonoma State University
AIS
da…@sonic.net