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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 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