As of January 1, 2022, patients will receive a copy of an invoice from the care provider for each consultation. This occurs in connection with the Cost containment package Amendments to the Health Insurance Act (KVG) are in force. It is intended to encourage patients to check the costs of their medical consultations and, if necessary, to file an objection. Unfortunately, understanding a medical bill requires knowledge that an average patient lacks. In order to clear up misunderstandings, we try to break down and explain the most important items in an ophthalmologist's bill.
Measurements and examinations are also carried out which cannot be billed but are part of the state of the art ophthalmology (e.g. measurement of glasses, automatic refractometry).
Compared to general practitioners, psychiatrists or other specialists, ophthalmologists require an above-average number of expensive devices, which must also be amortized. As a result, the bill for a brief examination by an ophthalmologist is above average compared to other doctors.
The exact amount that is invoiced for the corresponding item is online in TarMed browser is apparent and consists of a medical service and a technical service which is offset against the tax point value of the corresponding canton.
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If the consultation lasts longer than 5 minutes, a supplement may be charged for every five minutes.
Example: A consultation lasting a total of 30 minutes is billed as follows:
First 5 mins + every additional 5 mins (4 times) + last 5 mins
Consultation for people over 6 years of age and under 75 years of age, every additional 5 min.
For young children or older patients, other positions apply, as it is assumed that this patient population is more complex.
Adoption
Eye test by the optician/optometrist/ophthalmologist to determine the best possible visual acuity.
Eye test by the optician/optometrist/ophthalmologist to determine the best possible visual acuity including binocular adjustment if necessary.
When is that necessary?
As soon as the refraction, i.e. the correction of vision, changes, an extended refraction determination is necessary to find out whether the glasses are still correct or whether new glasses need to be prescribed. Maximum vision must be determined before eye surgery, as well as after the eye has recovered after surgery.
Discuss and explain a planned procedure or diagnosis (procedure, opportunities and risks), including adequate documentation of the patient information provided.
For young children or older patients, other positions apply, as it is assumed that this patient population is more complex.
To explain to the patient how to use and operate technical aids (e.g. eyelid care).
For young children or older patients, other positions apply, as it is assumed that this patient population is more complex.
Measurement of intraocular pressure by the optician/optometrist/ophthalmologist and evaluation of the optic nerve on the slit lamp.
When is that necessary?
As a rule, eye pressure is measured during all routine examinations. Increased eye pressure can lead to glaucoma and therefore directly threatens eyesight. Regular eye pressure measurement is also particularly important during post-operative checks following an intravireal injection, after cataract surgery or when the patient is using cortisone preparations.
The central retina is examined using a slit lamp with a magnifying glass (retinoscopy) and is also part of a routine ophthalmological examination. Macular edema, bleeding, retinal detachment and inflammation inside the eye are thus detected.
This involves examining not only the optic nerve and the central retina but also the peripheral areas of the retina.
When is that necessary?
In patients with diseases such as diabetes or high blood pressure, the outer retinal areas should also be examined, for example, for bleeding or vascular changes. By administering tropicamide eye drops, the pupil can be dilated and the entire peripheral retina can also be assessed. This is necessary, among other things, as soon as there is a suspicion of vitreous removal, retinal tear or detachment stands in the room.
A fundus image is a type of photograph of the retina.
When is that necessary?
As soon as an abnormality such as a retinal birthmark, retinal tear, retinal hemorrhage, etc. is detected or there is a systemic disease that could affect the retina (e.g. diabetes mellitus), a fundus is taken to document the findings. In later investigations, the images can be compared and a worsening or improvement can be identified.
As soon as an abnormality is discovered in biomicroscopy, i.e. during retinoscopy in the area of the macula or the optic nerve, scanning laser ophthalmoscopy is carried out using the OCT device.
This generates layers of retinal tissue, which are used on the one hand for diagnosis and documentation and on the other hand to indicate an operation.
When is that necessary?
In principle, all patients with diabetes mellitus are examined with an OCT device in order to identify diabetic macular edema at an early stage, as well as before intraocular surgery such as cataract surgery.
Before and during therapy with drugs that can alter the retina as a side effect (e.g. chemotherapy drugs, antirheumatic drugs), an OCT measurement is also carried out in order to be able to discontinue or change treatment early.
In patients with glaucoma (glaucoma), an OCT measurement of the nerve fiber layers on the optic nerve is also carried out at each consultation and compared with previous measurements. This is the only way to assess the progress of the disease or to measure the therapeutic success of eye pressure lowering drugs or treatments.
Even during routine examinations of patients aged 50 and over, OCT measurements as part of a screening of known retinal or glaucoma diseases in the family make sense. However, these may no longer be billed by health insurance for some time. The service provider can therefore decide for himself whether the measurements are not carried out, carried out and instead a fundus photo or billed as a self-payer benefit.
This involves injecting a contrast medium into the patient's vein and then photographing the retina with specially filtered light. This investigates the state of blood flow to the retina and whether there are vessels that leak and can lead to macular edema, for example.
When is that necessary?
After vascular occlusion or diabetic retinopathy
New, harmful vessels that cause macular edema, for example, can be detected using Angio-OCT even without the use of contrast medium.
There is currently no TARMED position
The Amsler grid is a grid of fine black lines on a white background with a central fixing point. It is a cheap and efficient way to subjectively check the central retina and macula. If the macula is thickened (e.g. with macular edema, epiretinal membrane), the patient sees the grid lines distorted or wavy. Macular defects include central visual field defects. After a positive test with the Amsler grid, an OCT measurement is usually carried out to determine the exact cause.
During gonioscopy, the angle of the chamber on the anterior segment of the eye is assessed with a slit lamp and, if necessary, with the aid of a gonioscopy magnifying glass.
When is that necessary?
This examination is particularly indicated in cases of glaucoma, intraocular inflammation, diabetes mellitus or following eye trauma.
The contact glass examination is also used to evaluate the peripheral retina.
The examination of the visual field is an important part of glaucoma diagnosis. In glaucoma, there is an increasing degeneration of retinal nerve fibers, which follows a typical pattern. This degeneration causes defects in the visual field. An increase in this defect indicates too high eye pressure and requires appropriate therapeutic measures.
The degeneration of the nerve fiber layer can be directly objectified using OCT measurement on the optic nerve.
Perimetry and OCT measurement make it possible to assess the progress of glaucoma and to measure the therapeutic success of eye pressure lowering drugs or other glaucoma treatments. These can be billed via TARMED if glaucoma is very advanced or is followed by an operation after the measurement.
Even during routine examinations of patients aged 50 and over, OCT measurements as part of a screening of known retinal or glaucoma diseases in the family make sense. However, these have not been able to be settled by health insurance for a few years.
There are ophthalmologists who therefore bill the OCT measurements as self-paying services, which must be communicated before the measurement.
If there is a suspicion of a neurological cause of eye symptoms, a neurological evaluation by an ophthalmologist is indicated. This includes tests to examine the function of various cranial nerves, such as field of vision, visual field, eye and eyelid movements, corneal sensitivity and pupil motor skills.
In the Schirmer test, tear production in the eye is measured with a strip of paper.
The fluorescein permeability test examines, on the one hand, the tear film and its stability on the cornea and, on the other hand, the outflow of the tear fluid.
When topographing the cornea, the surface of the cornea is measured. The result is a type of altitude map similar to the hiking map, where the differences in altitude are described by the deviation from a spherical surface (best-fit sphere).
When is this necessary?
Pachymetry measures the thickness of the cornea precisely. This can be done with ultrasound or with the Scheimpflugkamera.
When is this necessary?
This results in high-resolution cross-sections of the cornea to determine corneal thickness, depth of corneal scars, documentation of corneal meltdowns
Measuring corneal sensitivity
When there is herpes on the eye, the sensitivity of the cornea is reduced; here, the measurement is used to confirm the diagnosis. Before numerous operations on the anterior segment of the eye, irritating hair anesthesiometry is performed in order to be able to make a prognosis, e.g. with regard to eye dryness following a refractive procedure.
Patients who are blinded usually suffer from clouding of the optical media, e.g. turbidity in or on the cornea, clouding of the natural or artificial lens.
When is this necessary?
The endothelial cells line the back of the cornea and constantly pump water out of the cornea. In the case of corneal diseases or after intraocular surgery (e.g. cataract surgery), the number of endothelial cells may be reduced.
When is this necessary?
Evaluation and counting of the image of endothelial mirror microscopy
For example, expression of secretion from the meibomian glands due to meibomian dysfunction.
Emergency inconvention packages
How is the contingency of a constellation defined according to TARMED?
In the case of direct doctor-patinent contact: Any patient who develops a disturbance of vital functions regardless of the triggering cause is to be feared or cannot be ruled out. Also applies to patients for whom an acute illness, trauma or poisoning can cause or result in organ damage.
Without direct doctor - patient contact: Medically necessary and/or considered obviously necessary by the patient, relatives or third parties.
Depending on the time of the emergency service, different flat rates are charged:
For emergency consultations
Monday to Friday 7:00 a.m. to 7:00 p.m.
Saturday 7 a.m. to 12:00 p.m.
Monday to Sunday 19:00 to 22:00
Monday to Sunday 22:00 to 07:00
Reports of 11-35 lines to the insurance company, other doctors or to the patient.
