The FY2026 fee revision created the ophthalmology coordination add-on, which rewards coordination that moves a patient whose principal disease is diabetes from internal medicine to an ophthalmologist.
Here is what many ophthalmology practices miss. The add-on is billed not by ophthalmology but by the internal medicine side billing the lifestyle-disease management fee.
That does not make it irrelevant to ophthalmology — quite the opposite. The billing requirements include confirming whether the patient actually attended the ophthalmologist. In other words, without a reply letter from ophthalmology, the referring internist struggles to complete the requirement. The consequence: practices that reliably return reply letters attract more referrals.
This article organizes the mechanism and explains what ophthalmology can do to widen the referral inlet, from the perspective of chart operations.
Disclaimer: This article is general information. Points, requirements, and facility standards are governed by the ministry notification and regional bureau circulars, and change with revisions and clarifications. Base billing decisions on the latest primary sources.
Overview
| Item | Detail |
|---|---|
| Points | 60 (confirm against primary sources) |
| Frequency | Once per patient per year |
| Who bills it | Institutions billing the lifestyle-disease management fee (I) or (II) — typically internal medicine |
| Eligible patients | Patients whose principal disease is diabetes |
| Effective | 1 June 2026 |
A dental coordination add-on (60 points, once yearly) was created in the same framework, covering diabetes complication management in both directions.
The requirements
Organizing what has been published, the internal medicine side must broadly follow this sequence (confirm against primary sources):
- Determine, based on examination, that ophthalmic care is needed to prevent, diagnose, or treat diabetic complications
- Explain to the patient and obtain consent
- Provide patient information, with a document showing the clinical situation, to another insured institution with an ophthalmology department
- At the next consultation, confirm whether the patient attended that institution and record it in the medical record
Item 4 is what ophthalmology must understand
Item 4 is the key. The internist's obligation does not end at referral: they must confirm at the next consultation that the patient actually attended, and record it.
There are only two ways to do that:
- Ask the patient verbally
- Confirm via a reply letter from the ophthalmologist
The first depends on the patient's memory and is weak as documentary evidence. The reliable route is the second.
By design, then, this add-on makes the internist dependent on a reply letter from ophthalmology.
What changes for ophthalmology
A referral inlet now exists by design
Screening for diabetic retinopathy has long been clinically recommended. But for the internist, referring to ophthalmology was effort that earned nothing.
This add-on attaches 60 points once yearly to that act. Internists now have an economic reason to send diabetic patients to ophthalmology.
The number of patients billed the lifestyle-disease management fee with diabetes as the principal disease is substantial even at a single internal medicine clinic — and every one of them is a candidate for an annual eye examination.
Reply-letter capability becomes the reason you are chosen
This is where the business decision sits for ophthalmology.
To bill the add-on, the internist needs confirmation of attendance. An ophthalmology practice that returns reply letters reliably and quickly is an easy partner. One that does not reply, or takes weeks, is less likely to be chosen next time.
Reply-letter operations set the ceiling on referral volume. That was always true; the new add-on sharpens the internist's incentive, so the gap widens.
Diabetic retinopathy leads to ongoing management
Where a referred patient has retinopathy, what follows is chronic management.
- Annual screening even without retinopathy
- Shorter intervals from simple retinopathy onward
- Photocoagulation for pre-proliferative and proliferative disease; anti-VEGF injections for diabetic macular edema
Diabetic retinopathy can be designed as a pipeline of continuing visits, not a one-off referral. Within ophthalmic economics, chronic management stands alongside cataract surgery as a pillar.
Treatment interruption among diabetic patients is a serious clinical and business problem — see Preventing Treatment Interruption in Diabetes.
How to run reply-letter operations
"Return a reply letter" is easy to say; in practice there are several places it stalls.
Where the bottlenecks are
| Stage | Common stall |
|---|---|
| Receiving the referral | Arrives on paper; who received it becomes unclear |
| Linking to the visit | The referral and the actual attending patient are never connected |
| Writing the reply | No time after the consultation to write or type it |
| Sending the reply | Written but never sent |
| Tracking what is outstanding | Nobody knows which replies have not been returned |
The last row matters most. A reply letter is work whose absence is invisible. The consultation is over and the patient has gone. The only party who notices is the referring internist — and they express it by sending the next patient elsewhere.
What the chart needs to hold
- Referrer management: which institution referred which patient, and when
- Referral-to-visit linkage: receipt of the referral and the actual visit held as one record
- Drafting support: a reply draft generated from consultation records and examination values
- Outstanding alerts: a list of patients whose reply is unwritten or unsent
- Format retention: the diabetes eye record book and your own reply formats held as templates
What to put in the reply
The internist needs the fact of attendance and the ongoing management plan. These elements are generally sufficient:
- Date of visit
- Stage of retinopathy (findings)
- Examinations performed (fundus examination, OCT, etc.)
- Whether treatment is needed, and what
- When the next ophthalmology visit is scheduled
That last item serves both the internist's chronic management and the ophthalmologist's own follow-up attendance.
Running replies and coordination with AI Karte
Ophthalmology sees high daily patient volumes with short consultations. Carving out reply-writing time outside the consultation is not realistic.
Pottech's AI Karte supports coordination on that premise.
- Document generation: the AI drafts reply letters and referral documents from consultation records and examination values, with registered templates preserving your own formats. See Generative AI for Clinical Documents
- Device integration: when autorefractometer, tonometer, OCT, and fundus camera values and images flow into the chart automatically, transcription into the reply disappears. See Integrating Ophthalmic Devices with the Chart
- AI assistant: monitors visit intervals for patients needing regular follow-up and flags gaps. Diabetic retinopathy progresses with few symptoms, so a lapse in attendance translates directly into blindness risk
- Integration and APIs: an OAuth2 gateway, MCP server, and HAPI FHIR connect referral and reply exchange to coordination infrastructure
Lowering the cost of replying means increasing the volume of referrals you can absorb.
In closing
The ophthalmology coordination add-on is not billed by ophthalmology. But it is an add-on whose referral volume depends on how ophthalmology operates.
Three points:
- It is billed by the internal medicine side under the lifestyle-disease management fee: 60 points, once per patient per year, for patients whose principal disease is diabetes
- Because the requirements include confirming attendance and recording it, the internist needs a reply letter from ophthalmology
- A practice that replies reliably and quickly becomes the referral inlet
Being able to tell local internal medicine clinics "we will take your diabetic retinopathy screening and return reply letters reliably" is clear differentiation under this revision.
For the ophthalmic revision as a whole see Ophthalmology and the FY2026 Fee Revision; for the internal medicine perspective see Diabetes Medicine and the FY2026 Fee Revision; for audit deductions see Reducing Ophthalmic Rezept Audit Deductions.
To discuss system design for coordination workflows, please contact us.
References and Sources
- About the FY2026 (Reiwa 8) Fee Revision | MHLW
- FY2026 revision: new add-ons for ophthalmology and dental coordination for diabetic patients under the lifestyle-disease management fee | Diabetes Resource Guide
- What is the new "ophthalmology coordination add-on"? (FY2026 revision) | Doctor's Chart
- Impact of the 2026 fee revision on ophthalmology clinics | Funai Soken
Note: points, requirements, and facility standards change with revisions and clarifications. Always confirm the latest fee schedule and circulars published by the MHLW and the regional bureaus.