AllMed Helps Health Plans Learn How to Use Visual Field Testing To Determine Medical Necessity of Blepharoplasty

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Health plans and medical management organizations often struggle with understanding when eyelid surgery is medically necessary and when it is cosmetic. During a recent webinar hosted by AllMed Healthcare Management, Dr. Michael Wheatley discussed issues related to determining medical necessity for blepharoplasty.

Improving the Quality & Integrity of Healthcare

"The problem is that there are many patients requesting blepharoplasty for cosmetic indications, who are looking for insurance coverage to avoid having to pay for it." - Dr. Wheatley

Blepharoplasty involves the surgical removal of excess skin and fatty tissue around the eyes. The three most common indications that patients present when seeking blepharoplasty, said Dr. Wheatley, are dry eyes, difficulty seeing and excessive tearing. Even a small degree of superior visual field obstruction, he noted, can affect activities of daily living.

According to Dr. Wheatley, a board-certified plastic surgeon, "Patients with visual field obstruction resulting from eyelid drooping or other conditions can significantly benefit from blepharoplasty." Current blepharoplasty guidelines developed by several professional societies and organizations have varying requirements for specific visual field testing and/or photographic findings.

Regardless of the specific requirements of various health plans for covering blepharoplasty, determining medical necessity must be supported with thorough clinical documentation including:

  • Medical History
  • Physical Exam
  • Visual Field Testing
  • Photography

Together, these components of the patient workup should fit together to form a cohesive whole picture. "If any one of these components is an outlier or if findings are inconsistent, then that would suggest that the procedure is cosmetic," said Dr. Wheatley. "Some patients may manipulate visual field test findings, so it is critical for photographic findings to be consistent with test results." Independent medical review is valuable in determining medical necessity since blepharoplasty cases can vary subtly. "Using a board-certified physician who looks at a lot of these cases and performs the actual procedures can really be helpful to evaluate the visual field studies and the quality of photographs."

To access the recorded webinar: http://bit.ly/PSkqcH AllMed also release a companion white paper, to download: http://bit.ly/SRoJDe

About AllMed
AllMed Healthcare Management provides physician review outsourcing solutions to leading health plans, medical management organizations, TPAs and integrated health systems, nationwide. AllMed offers MedReview® , MedCert® , and MedDirector® services that cover initial pre-authorizations and both internal and external appeals, drawing on a panel of over 400 board-certified specialists in all areas of medicine. Services are deployed through PeerPoint , ALlMed's state-of-the-art medical review portal. For more information on how Allmed can help your organization improve the quality and integrity of healthcare, contact us today at info(at)allmedmd.com or visit us at http://www.allmedmd.com

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Kiki Grant
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