Download UNIVERSITY EYE INSTITUTE CORNEA AND CONTACT LENS

Cornea and Contact Lens Service
(CCLS)
Services
 Primary Care
 Specialty Care
 Contact Lenses
What to Bring to Clinic
 All things necessary in family practice service plus…
1. CL Magnifying loupe
2. Green suction cup(s)
3. Wratten filter (yellow)
4. GP diagnostic set
5. Tyler’s Quarterly
Auxiliary Items
 Consultation room
 Fit guides for specialty lenses
 Computers: Toric Cross Cylinder Calculation
 Computers: Microsoft Word- Internal/External referrals
 Corneal Topographers
 Autokeratometer/Autorefractor
 NCT
 FDT
 Visante Anterior Segment OCT
 Specular Microscope Camera
 Confocal Microscope
 Lenstar
Scheduling
 Three (one-hour) appointment slots per half day
 One complete exam plus one progress visit


2 hours for a full exam and contact lens fit
1 hour progress visit
 Three contact lens progress visits

3 (1 hour) progress visits
“Day Sheet”
 A “Day Sheet” will be available at the reception window
prior to the beginning of each clinic session
 Initial next to the patient’s name that you would like to
examine
 Review patient charts
Pre-Clinic Seminars
 Your attending will give responsibilities and expectations the
first session of the first full week of clinic
 Mornings – 8:30 AM
 Have your assigned exam room set up and be logged on to
EMR by 8:00 AM
 Afternoons – 1:30 PM
 Have your assigned exam room set up and be logged on to
EMR by 1:00 PM
Notification
• Review EMR before clinic seminar begins
• You will be notified over the PA system that the patient has
arrived
• Be sure to collect the superbill as you pick up the patient
Notification
 EMR – right click on room and select your exam room
number when you have picked up your patient
Stay On Time
 You must complete appropriate care within the time period
assigned
 Notify your attending within ten minutes of the next
appointment time if there will be a delay
 Always consult with your assigned attending
Be Available
 Do not leave the CCLS area without checking with both
your attending faculty and the clinic staff to make sure that
you have not been assigned a patient
Adding a patient
Search for pt by DOB found on super bill
Do NOT Create a “new patient”
Must now click on each header; ocular and systemic medications EVEN if the
patient does not take either (even though the template already reflects a
normative statement of no medication usage)
Click on one for “No medication usage” and one for “No medication allergy”.
(Green box)- if your patient is not on medication
Use the radio buttons to
go between Ocular and
systemic meds.
Diagnostic (Trial) Soft Cls
•A signed disposable trial lens Rx form must be
provided in order for lenses to be dispensed by
the stock room (1400) staff. (Appendix 1)
Diagnostic Lenses, GPs
 Always verify diagnostic GP base curves and powers
 In order to reduce the risk of ocular infection, always …
 Wash your hands before handling lenses
 Clean and rinse all lenses before application
 Rub all lenses with appropriate rewetting solution
Additional Items
 Addipak solution, Purilens solution
 Large and Small DMV
 Optimum Extra Strength Cleaner
 Unique PH
 Progent
 High Molecular NaFl
 Lissamine Green
Items Charged in EMR
Use Code: 99070
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Addipak/Purilens
Large and Small DMV
Extra Strength Cleaner
Unique PH
Progent
Shipping and handling
Shipping and handling overnight
Dry Eye Supplies
Lens Stock Room (1400)
 You are responsible for the safe return of all equipment, un-
used solution (Addipak vials) and/or diagnostic lenses by
the end of the clinic session
 GP lenses used from diagnostic lens sets are to be cleaned,
rinsed (with saline), and dried prior to their return.
 Store lenses dry
CL Lens Lab (1421)
Modification Room
 Contains modification and verification equipment.
 Modification units
 Lensometers
 Radiuscopes
Consultation Room (1411)
 Contains:
 forms (dilation refusal, records release …)
 CL fit guides
 telephone (you must call all no-show patients and document in
the chart under the “no-show” template)
 two computers
 a projector
 a printer
Contact Lens Dispensing
 All contact lenses must be verified before they are dispensed
 GP lenses must have base curve, power, diameter, optical
zone, center thickness, and edges measured and/or
inspected
 Soft lenses must have their packaged label verified with the
order form before the vials or boxes are opened
Contact Lens Dispensing
 Any time contact lenses are verified, initial “Verified by” and
fill in the date on the order form (Appendix 2)
 When dispensed, initial “Delivered to patient by,” record the
date on the order form and return it to the stock room
Appendix 2
x
x
Smith,
Joe
x
7.52 -2.00
7.55 -2.00
9.2
Boston XO
9.2
Boston XO
x
ED
04/19/`2011
ED
04/19/2011
Contact Lens Dispensing
 EMPTY lens vials or GP cases are to be given to Jim in
the stock room.
 Please give Jim the entire tray with specific instructions
 Return empty lens trays to the stock room
DO NOT LEAVE TRAYS OR LENSES IN THE
EXAMINATION ROOM
DO NOT THROW AWAY CL VIALS OR GP CASES
Contact Lens Dispensing
 If the lenses do not verify correctly:
 Record on the order form exactly what is out of tolerance and
the measurement obtained
 Return the tray with the lenses and the order form to the
stock room
 Complete a pink lens return form (Appendix 3)
 Write up a new order form
Appendix 3 Lens return
REPLACE
UEI CCLS Fees
 CCLS Fitting Fees:
 Global fitting fees: new patients being fitted with contact
lenses for the first time

Includes follow-up (adaptive) visits: 45, 90, and 120 days
 Per visit (pay as you go) fees: Established patients only.
 All fees must be paid at the time services are provided
 All lenses must be paid in full (100% ) before ordering
Contact Fitting Fees
 All of the fitting fee codes are:
92310
 Except:
92072 (Keratoconus)
UEI CCLS Coding
 Contact lens fit:
 92310: CL Professional Fitting-Daily

Sphere GPs or SCLs
 92310: CL Professional Fitting-Complex

Toric, MF or monovision
 92310: CL Fit Therapeutic (soft or GP)

Post surgical, corneal scarring, or scleral lens fit, prosthetic
 92310: Orthokeratology
 92072: Management of Keratoconus

Soft, GP, hybrid, scleral
UEI CCLS Coding
Non-Global
Global
 Full Eye Exam and Fit
 Code for comprehensive eye exam
 Contact lens fit:
 92310: CL Professional Fitting-Daily
 92310: CL Professional Fitting-Complex
 92310: CL Fit Therapeutic (soft or GP)
 92072: Mngmt of Keratoconus (any lens)
 92310: CL Office Visit/Progress
UEI CCLS Coding
 Z-Code
 Z01.00 Vision exam w/o abnormal findings
 Z01.01 Vision exam with abnormal findings
UEI CCLS Fees
 At the conclusion of the appointment, determine the
appropriate fee the contact lens fitting and check-off any
and all procedures performed on both the superbill
(Appendix 4-Front) and the EMR coding and procedures
 All superbills must then be approved and signed by your
attending faculty
 Coding on the superbill must match coding in EMR
UEI CCLS Fees
 The fees for lenses are posted in every exam room
(Appendices 5a, 5b)
Appendix 5a
Appendix 5b
UEI CCLS Fees
 Make sure that you are charging the patient the correct lens
contact lens material fees (Appendix 4-back)
 Do not charge for a ProClear Toric when a ProClear Toric XR
lens has been ordered
 Even some spherical lenses will increase in price depending on
their power
Appendix 4-Back
UEI CCLS Fees
 Once the superbill is signed STOP at the CCLS staff office
 Confirm fees
 Schedule follow-up appointment (if necessary)
 Escort the patient to the optical or cashier in the main lobby
for payment
Fee Reduction
 Fee Waivers
 If there is a situation where patient needs a reduction in fees,
the contact lens service fees will be reduced by the percentage
indicated on a “Fee Adjustment Form” (Appendix 6)
 The normal fee for contact lens materials is not reduced
Appendix 6
Closing Times
 The CCLS and the UEI cashier closes at 6:00 PM
 All appointments for return visits must be made prior to 5:30
PM even if you will be working with the patient past closing
Records Completion
 All EMR records must be completed within 24 hours
 Once completed, update patient room to “closed record” so
that your attending will know that you have completed the
chart
 Enter patient interaction online for evaluation purposes
 https://www.meditrek.com
Patient Care Protocols
 The CCLS will adhere to the Minimum Optometric Data
Base as described within the UEI Clinic Policy Manual
and/or the Texas Optometry Board
 All patients will be dilated unless contraindicated or the
patient refuses
 The patient may elect to have OPTOMAP imaging performed
 If a patient refuses dilation, they must sign a “Refusal of
Dilation” form (Appendix 7) in order to continue care at
UEI
Appendix 7
Would this be
coded as a
Comprehensive
Ophthalmologic
eye exam 920X4?
Intermediate Ophthalmologic Exam
920X2
Patient Recall
 Patient return visit information is to be recorded in the
EMR under “Orders”
 Recall cards will be sent out based upon this information.
 Yearly complete examinations are required if the patient
wishes to continue receiving lenses through the UEI
Ordering Procedures
 Always create a lab order in the EMR when ordering
CLs. This will post the charges to the patient’s account.
List number of BOXES for soft and number of
LENSES for GPs.
Ordering GPs after using diagnostic lenses in clinic
Ordering Procedures
The UEI CCLS “Contact Lens
Order/Reorder” referred to as the “order
form” will be used for all contact lens orders
(Appendix 2)
This form must be filled out completely to
aid CCLS staff and clinicians in prompt
and efficient processing
Ordering Procedures
 Lens parameters should be entered in the usual fashion
 Remember to indicate manufacturer and tint, particularly
when ordering GP lenses
 Do not forget to mark dispensing instructions, i.e.,
“appointment required” or “dispense without appointment,”
etc
 For soft contact lenses indicate if you are ordering boxes of
lenses or trial lenses
 The lower right side of the order form contains delivery and
patient notification information
Appendix 3
Ordering Procedures
 The completed order form is to be turned in to the stock
room (1400)
 When you dispense lenses, fill in your name in the “Delivered
to Patient by” slot and record the date
 Return the order form to the stock room
Lens Orders
 Most contact lenses may be ordered on either a “warranty”
or “non-warranty” basis
 Warranty: This is the same as a “guaranteed fit” lens order
 Non-Warranty: Lenses ordered on this basis carry a
“product warranty” only
Complimentary Lens Orders
 Any comp orders must be clearly marked on the order form
that it is for an optometry student
 Most manufacturers may require special forms to be
completed

These forms can be found at the stock room window
 Write, “COMP / OPT III STUDENT”, or whatever year they
are, on the order form

Failure to do so may result in charges
Complimentary Lens Orders
 Students are not permitted to schedule a full eye exam and
contact lens fit during the last 3 weeks of the semester
 This also applies to immediate family members
Patient Records
 All records should be maintained as indicated in the records
section of the UEI Clinical Services Manual
 Return all paper charts by the end of each clinic session
 Complete all EMRs within 24 hours
 Do not leave CL orders in the room
 All CL orders should be signed and turned in for processing
by the end of the clinic session
No Shows
 If a patient fails to keep their appointment, confirm with
the receptionist whether or not they had already
rescheduled. If not, call the patient
 All “no shows” and any telephone conversations or messages
left must be dated and documented in the EMR using the
“All Services Patient No Show” template
 When is a patient a “no show”?
 Officially at 30 minutes
 However, many times there are extenuating circumstances
No show template
CL Prescription Release
 No contact lens prescription will be released to the patient
during the adaptation period or before all fees are paid in
full
 Once the patient has successfully adapted to their lenses, a
complete prescription MUST be released. If it doesn’t print
then hand write a CLRx (Appendix 8)
Appendix 8
Requesting Records for Patients
 You may request patient information using the form in
Appendix 9
 The patient must fill out the form and sign
Appendix 9
Referrals
 All primary ophthalmological referrals will be made to the
UEI Medical Service
 Acute situations will be handled at the discretion of the
attending faculty
 Any referral, internal or external, must have the appropriate
referral letter and/or referral form completed
Lens Returns - Exchange
 Three situations which require lens returns (Note that all
lenses being returned must be in their original vials/cases)
 LENSES NOT AS ORDERED – CANNOT BE WORN
 LENSES NOT AS ORDERED – CAN BE WORN
 LENSES OK or NOT AS ORDERED – CHANGING
PARAMETERS
Review scenarios in your handout