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Coding, Contracts and Community: Six Pearls from the 2010 YO Program
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Wow! What a week. As I head home from my first Academy meeting, I finally have the time to reflect on what an outstanding organization our Academy really is. I got to meet with receptive, accomplished and caring established ophthalmologists. I was exposed to well-organized lectures and discussions about the new thoughts and advancements in each of our subspecialty areas and got to play with some neat new toys on the exhibit floor. The most memorable part was my interaction with the motivated, energetic and focused budding physicians in our field at the Young Ophthalmologist Program.

The YO Committee is one of the most accessible, exciting and, for many of us just starting our careers, the most useful resources our Academy has to offer. At the YO program:

  • We learned about the history of our Academy, what the Academy does for us as ophthalmologists, including, with our financial and political help, its involvement in strong political advocacy groups. These groups provide protection and support for our patients and our profession at the local, state and national level through a well-organized lobby.
  • We heard from the president of the Academy, Randy Johnston, MD, about how the Academy can be used as an educational tool outside of our residency and from Sue Vicchrilli, COT, COS, the Academy's coding executive, who discussed coding.
  • The YO Committee organized a group of ophthalmologists to talk about their personal experience in different types of practice settings: academic, as a solo practitioner, as a part of a small group or working under the umbrella of a large insurance company. It was enlightening to be able to compare and contrast these different practice options and ask questions directly to individuals who live the life every day.
  • William Lloyd III, MD, discussed the importance of work/life balance.
  • We even heard from Robert Wade, a lawyer, about contract negotiation.

I wish every young ophthalmologist could have made it to this excellent program, but as we all know, sometimes being the “young ophthalmologist” in training or in practice means you can’t make it to a lot of things. I hope you make it in the future, but I’ll include some facts that I found interesting from the meeting to hopefully help you.

1. What is EyeWiki? It is an online open forum for all ophthalmologists to collaborate, educate and share information. You can use it to study for the boards, or add to the educational content yourself. Try it! EyeWiki has had over 22,000 page views in just a few months. Editor's note: Hear more about EyeWiki from editors Aaron Miller, MD, and Brad Feldman, MD, who spoke to YO Info earlier this year.

2. You can’t get enough of Facebook? Try the Academy’s social forum on the Ophthalmic News and Education (ONE™) Network to connect, discuss and learn with our ophthalmology colleagues. Editor's note: You can also view and share photos from the Joint Meeting in Chicago, connect with colleagues you met at the YO Program and much more. It's all at

3. Do you know the difference between “occurrence-based” and “claims-made” malpractice insurance? Under an occurrence-based policy, you are covered for claims that occur during the time you had the policy. Under a claims-made policy, insurance must be in place when the claim is filed. This is important to understand when signing a contract, because under claims-made policies, “tail coverage” must be purchased after termination of employment to cover post-termination claims. The cost of this “tail” can be one to one-and-a-half times the cost of the annual premium. You may never see yourself leaving a practice, but if you need a change for whatever reason, the need for and the cost of a tail could become an issue.

4. Should you take non-compete clauses seriously when signing a contract? Yes, contrary to popular belief, restrictive covenants are enforceable, except in a few states, and can be a real headache for a physician wanting to change jobs. While in most states, a court can reduce the geographic scope of the non-compete to something it deems reasonable, working with the courts on your restrictive covenant is likely not the first thing you want to think about when changing practices. It pays to pay attention to the terms of the covenant when negotiating your contract. Editor’s note: For more on this, refer to Rob Wade’s article on contract negotiation.

5. What can you do if the practice you want to join still wants a non-compete? Many practices will insist you sign a restrictive covenant, and if so, there are ways to make them more acceptable. For example, you could have the non-compete clause not apply if you are terminated by the practice. This would avoid the worst-case scenario of you getting fired and being forced to relocate because of something you signed.

You could also have the non-compete void if your employment ends within the first year. Lets face it, sometimes partnerships don’t work out, and if this happens within the first year, it would be a shame to relocate your life and family after such a short period. Employers may find this agreement fair because after a year in an area you pose less risk than if you had been established for many years.

6. Do you know that there are 24 CPT modifiers and 11 HCPCS modifiers commonly used in ophthalmology claim submissions? Neither did I, and there are a lot of other things I didn’t know about billing. I learned that modifier -24 can be used to modify E&M (99XXX) or eye codes (92XXX) to bill for service during the postoperative period for an unrelated service.

If that is confusing, hopefully, this example will help. If you perform an eyelid lesion excision on a patient, the global postoperative period is 10 days. If they come in with a problem in another eye or with something unrelated to the surgery and you don’t add modifier -24 you won’t get paid. A new diagnosis isn’t good enough! Slap on modifier 24 and you should be in good shape.

There is not enough space to talk about everything covered at the meeting, however, I wanted to include some of the things discussed at the work-life balance talk. Dr. Lloyd noted that it is important to write down your life goals with three facets: personal, professional and economic. These three pillars may not complement each other and, placing emphasis on one may affect the other two. 

Be honest with yourself when making these goals and use them to help you choose your future practice. Finally, I will close with some wise words from Dr. Lloyd, “As long as you have options, you have freedom.” So, go get some options… No, not the type they trade on Wall Street! …You know what I mean!

Share your pearls from Chicago and you could win!
From now until Nov. 5, post your pearls in the Annual Meeting group, and you'll be entered to win one of three $50 Academy Store vouchers. While you're there, be sure to check out the gallery of meeting photos, including pictures from the YO reception.

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Christopher Chambers, MDAbout the author: Christopher Chambers, MD, is an oculoplastics fellow at the University of Pennsylvania/Scheie Eye Institute and at the Children's Hospital of Philadelphia, following a residency at the Kresge Eye Institute, where he was chief resident. He comes from a family of ophthalmologists, with both his father in the field and his sister entering her residency next year, and did his medical training at Ohio State University.

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