Download OCULARISTRY PROVIDER QUALITY ASSURANCE

OCULARISTRY PROVIDER QUALITY ASSURANCE POLICY DOCUMENT
OCULARISTS ASSOCIATION OF SOUTHERN AFRICA
OASA Policy 007
This policy adopted by members of OASA
On the 16 day of November 2010
____________________
President: Pedro Carvalho
Amended on the 03 Day of July 2015
OCULARISTRY PROVIDER QUALITY ASSURANCE POLICY DOCUMENT
OCULARISTS ASSOCIATION OF SOUTHERN AFRICA
Table of Contents:
1.
Disclaimer / Usage of this Policy / Principles of this Policy
Page 3
2.
Interpretation / Glossary
Page 4
3.
Introduction
Page 7
4.
Peer Review
Page 8
5.
Methodology
Page 9
6.
Procedure Details
Page 10
7.
SAOA – Procedure codes Series 5000/Ocular Prosthetics
Procedure codes maintained by Optical Assistant (Neutral Third Party)
Page 25
2
OCULARISTRY PROVIDER QUALITY ASSURANCE POLICY DOCUMENT
OCULARISTS ASSOCIATION OF SOUTHERN AFRICA
1.
DISCLAIMER
a. The Ocularists Association of Southern Africa has made every effort to ensure that:
i. the standards contained herein are as comprehensive and error free as possible.
ii. users of these standards shall bear the responsibility of any action that may arise from
the omission or lack of accuracy of these standards.
iii. the information and recommendations contained in this document have been provided
in good faith.
iv. the consequences of any action taken by any person as a result of information
contained in or omitted from this document is not the responsibility of the Ocularists
Association of Southern Africa nor any person/s or organization/s linked with this
document, nor sources of reference.
2.
USAGE OF THIS POLICY
a.
3.
This document is intended for:
i. the use of the profession of Ocularistry without limitation to any independent practice,
group practice, network, public or private sector.
ii. recommending standards to introduce a policy of quality assurance including continual
improvement of the service provided by all Registered Ocularists.
PRINCIPLES OF THIS POLICY
a. The Ocularists Association of Southern Africa promotes, without reservation:
i. access to health care
ii. embraces all principles contained in the Health Charter in the Bill of Rights as
incorporated in the Constitution of the Republic of South Africa, 1996.
iii. the expectation that these policy standards will be upheld.
3
1.
Interpretation/Glossary
1.1 Ocularistry shall mean the profession populated by Ocularists.
1.2 Ocularist shall mean a trained professional who fits and manufactures custom designed Ocular
Prostheses and Scleral Shells.
1.3 Phthysical Eye shall mean an eye where injury or disease has resulted in loss of function and
shrinkage in size of the globe.
1.4 Enucleation shall mean the removal of the eye with the remaining orbital contents intact. Where
possible, the four extra-ocular eye muscles are attached to an orbital implant.
1.5 Evisceration shall mean the removal of the eye's contents, leaving the scleral shell and extra-ocular
muscles intact.
1.6 Exenteration shall mean complete surgical removal of the contents of the orbit, including the
eyeball, fat, muscles and other adjacent structures.
1.7 Socket shall mean the bony cavity of the skull which normally contains the eyeball and its
associated muscles, vessels and nerves. The socket also refers to the bony cavity after evisceration,
enucleation or exenteration.
1.8 Ocular Prosthesis shall mean an artificial eye which is a type of craniofacial prosthesis used to
restore crucial orbital function and structure.
1.9 Haptic Shell or Scleral Shell shall mean a Haptic Lens which is an Ocular Prosthesis fitting over the
scleral surface of the phthysical eye.
1.10 Sclera shall mean the dense, white, fibrous outer membrane encapsulating all of the eyeball
except the cornea.
1.11 Cornea shall mean the transparent, anterior window of the external membrane of the eye which is
continuous with the sclera.
1.12 Microphthalmia shall mean an eye abnormality that arises before birth where one or both
eyeballs are abnormally small.
1.13 Enophthalmos shall mean the recession of the eyeball into the orbit.
1.14 Motility Coupling Device shall mean the implant to Prosthesis coupling device.
1.15 Fornices shall mean Conjunctival fornix: The fornix of the conjunctivae refers to loose arching folds
connecting the conjunctival membrane lining the inside of the eyelid with the conjunctival
membrane covering the eyeball. In anatomy, a vault like or arched structure.
1.16 Implant shall mean an Orbital Implant which is placed within the socket after removal of the eye to
restore volume to the eye socket and enhance movement or motility of an Ocular Prosthesis and
eyelids.
1.17 Implant Migration shall mean the migration of a surgical implant in the eye socket.
4
1.18 MOI shall mean OASA’s Memorandum of Incorporation.
1.19 Member shall mean a member of OASA referred to in Article 8 of the OASA MOI.
1.20 HPCSA or Council shall mean the Health Professions Council of South Africa.
1.21 OASA shall mean the Ocularists Association of Southern Africa.
1.22 Association shall mean the Ocularists Association of Southern Africa (OASA)
1.23 OASA Membership number shall mean the designated number given to each OASA member upon
registration to OASA in accordance with the MOI.
1.24 SAOA shall mean the South African Optometric Association.
1.25 Scope of Practice shall mean the examination and assessment of the globe, socket and related
structures to facilitate the manufacture and fitting of the appropriate, comfortable and safe
prosthesis or prostheses and/or appliance or appliances to restore the dignity, appearance and
functionality of the patient. This includes the eye socket, blinded eye, phthysical eye and the
surroundings. The Profession of Ocularistry assists patients to become more functional and to
restore the appearance, and where necessary, collaborates with Ophthalmologists, Plastic
Reconstructive Surgeons, Psychologists, Psychiatrists and Maxillofacial Surgeons. Ocularists
promote orbital and ocular health by rehabilitating the socket / orbit through manufacturing,
fitting and maintaining of ocular prostheses and scleral / haptic shells for those who have had an
eye or eyes enucleated, eviscerated, exenterated and those with total or partial vision loss and with
an unsightly, damaged and/or disfigured eye known as a phthysical blinded eye.
1.26 Custom Ocular Prosthesis shall mean a Prosthesis that is fitted over an orbital implant or fills the
entire eye socket. These Prostheses are close fitting and the fabrication requires accurate
impressions. These Prostheses are manufactured from medical grade acrylic resin.
1.27 Pre - Fabricated Ocular Prosthesis shall mean a Prosthesis fitted from stock, either manufactured
by a trade supplier or by the Ocularist, and may be modified by the Ocularist. These Prostheses are
manufactured from medical grade acrylic resin.
1.28 Acrylic Prosthesis shall mean a medical grade acrylic resin Ocular Prosthesis.
1.29 Glass Eye shall mean a pre-fabricated Ocular Prosthesis manufactured from cryolite glass.
1.30 Ombudsman shall mean the Ombudsman appointed by OASA.
1.31 POPI Act shall mean the Protection of Personal Information Act, No 4 of 2013 (Act) of South Africa.
1.32 CPD shall mean Continuing Professional Development
1.33 Labour Act shall mean the Basic Conditions of Employment Act, 2002 and as amended.
1.34 Explanation of Code Grading:
5
RSV Point
Time
Skill
Risk
Equipment
Relativity Service Value points use consultation as 100 points as a base line. Each practice will use its
own monetary value for points.
In minutes, approximate.
Score out of 5, (1 = min; 5 = max)
Skill and experience needed for any given task.
Score out of 5, (1 = min; 5 = max) Risk of repeating any given task.
Score out of 5, (1 = min; 5 = max)
Expense of and/or number of pieces of equipment required to achieve any given task.
6
2.
Introduction
2.1 Ocularistry
2.1.1
The Profession of Ocularistry promotes orbital and ocular health by rehabilitating the
socket and orbit or ocular contours through fitting, manufacturing and maintaining of
Ocular Prostheses and scleral / haptic shells for those who have had an eye or eyes
enucleated, eviscerated or exenterated; and those with total or partial visual loss as well
as with unsightly, damaged and/or disfigured eyes known as phthysical blinded eyes.
2.1.2
The Ocularist's domain is manufacturing and fitting of Ocular Prosthetics in accordance
with OASA’s Scope of Practice.
2.1.3
Scope of Practice: The examination and assessment of the globe, socket and related
structures to facilitate the manufacture and fitting of the appropriate, comfortable and
safe prosthesis or prostheses and/or appliance or appliances to restore the dignity,
appearance and functionality of the patient. This includes the eye socket, blinded eye,
phthysical eye and the surroundings (__?). The Profession of Ocularistry assists patients
to become more functional and to restore the appearance, and where necessary,
collaborates with Ophthalmologists, Plastic Reconstructive Surgeons, Psychologists,
Psychiatrists and Maxillofacial Surgeons. Ocularists promote orbital and ocular health by
rehabilitating the socket / orbit through manufacturing, fitting and maintaining of ocular
prostheses and scleral / haptic shells for those who have had an eye or eyes enucleated,
eviscerated, exenterated and those with total or partial vision loss and with an
unsightly, damaged and/or disfigured eye known as a phthysical blinded eye.
2.1.4
The Profession of Ocularistry intervenes to assist the patient in becoming more
functional, restores and maintains the orbital structural integrity and to restore their
appearance.
2.1.5
An Ocularist is a trained Professional who consults, advises, fits and manufactures
Ocular Prostheses.
2.1.6
An Ocularist is qualified to fit Scleral or Haptic Shells.
2.1.7
This document encapsulates the system, tools and methods used to accredit Ocularists
in a fair and an unbiased manner.
7
3.
Peer Review System
3.1 A peer review system is utilised by OASA to establish whether the standards contained in this
Quality Assurance Policy are being upheld.
Domain
Designation Criteria
HPCSA Registration
CPD Portfolio
Informed Consent
Consultations
Patient Records
POPIA
Patient Education
Treatment Options and Costs
Storage of Ocularistry
Manufacturing Materials
Storage of contact lens and
related products
Administration of all
materials and related
substances
Practice Service Knowledge
Recruitment and dismissal
procedures
Protection from abuse and
discrimination
Autonomy of patient
management
Disposal of Hazardous
Materials
Insurance
Health & safety
First Aid
Fire & disaster planning
Equipment
Claims Management System
General Ocularistry care
Related disciplines
Quality Standard
Existing Ocularists: Matriculation Certificate; 5 Year Apprenticeship; at least
15 Years Private Practice to obtain Ocularists Registration through
Recognition of Prior Learning.
Future Ocularists: National Senior Certificate; 360 Credit Diploma to be
registered.
OASA will be seeking registration with HPCSA. HPCSA principles are
voluntarily upheld by OASA.
Active CPD compliance.
Consent procedures and Consent Forms.
Respecting patients including all aspects of privacy in consultation, compliant
with the Health Charter.
To include clinical history and observations, diagnosis, methodology and ongoing management.
All documentation stored in accordance with the POPI Act.
Comprehensive written information regarding their condition.
Written treatment and cost options.
Meets manufacturer and regulatory standards.
Meets manufacturer and regulatory standards.
Record detail of material or substance administered and response.
All practice staff to be conversant with the services offered.
As per individual practice policies in compliance with the Labour Act of South
Africa.
All matters to be deferred to the OASA Ombudsman.
Ocularists are autonomous in their patient management.
Meets with manufacturers and regulatory standards. Use and disposal of
materials is according to relevant legislation.
Professional indemnity, practice contents, practice liability, product
insurance.
Adequate space, lighting, ventilation, cleanliness and comfort. Wash basin
available for hand washing.
Appropriate first aid kit available in accordance with the relevant regulations.
Serviced fire extinguisher and emergency evacuation plan in place.
Practice equipment supports practice aims.
Approved system to manage all third party claims.
Consultation time by the registered Ocularist is adequate to explain diagnosis,
management, care (including after care) and cost.
Co-management, where necessary, through related professionals.
8
4.
Methodology
4.1 Custom, Haptic Shells and Pre-fabricated Ocular Prostheses:
4.1.1
Ocularists utilize one or several combined fitting and manufacturing techniques. The
manufacturing process begins with the initial fitting procedure and continues until the
Ocular Prosthesis is finalised and fitted in the patient’s eye socket or over their
phthysical eye.
4.1.2
The patient care team may be expanded to include other disciplines, for instance
Ophthalmologists, Plastic Reconstructive Surgeons, Psychologists, Psychiatrists,
Optometrists and Maxillofacial Surgeons.
4.2 Ocularists have appropriate equipment and materials, although there will be some variances in
practice methods.
4.3 Worldwide there are two main mediums for manufacturing ocular prosthetics, namely medical
grade acrylic resin and cryolite glass.
4.4 Internationally, the lifespan of an acrylic ocular prosthesis is five years, thereafter the acrylic
deteriorates to a point that it may be detrimental to the wellbeing of the socket. The lifespan of a
glass ocular prosthesis is 2 years.
4.4.1
In cases where there has been surgical intervention during the ocular prosthesis’ life
cycle, it is customary to manufacture a new ocular prosthesis due to the surgically
induced changes in the socket.
4.4.2
The lifespan of an Ocular Prosthesis can be detrimentally affected when contraindicated drugs are administrated, or any other non-compatible cleaning material is
applied to a Prosthesis. This will necessitate the replacement of the Ocular Prosthesis to
prevent any damage to the socket.
4.4.3
An Ocular Prosthesis needs to be replaced before the indicated lifespan if the socket or
ocular surface or orbital shape changes. This could be due to implant migration, weight
fluctuation or a variety of other reasons.
4.5 In the case of young children, it is important to note that the Ocular Prosthesis needs frequent,
regular monitoring and alterations, even multiple replacements in a single year to accommodate
the growing child’s changing socket.
4.5.1
Where the Prosthesis is not regularly altered to accommodate the growth of the child,
consequences can include deformities of the facial structure which in some cases can
require facial reconstructive surgical intervention to rectify.
4.5.2
Children’s sockets stabilise by approximately the age of 18 years, and the adult
replacement lifespan cycle normalises.
4.6 Annual consultation and surface evaluation is necessary for all patients. Small children will need
more regular assessments.
4.6.1
Annual polishing is very important to maintain the surface of the Prosthesis, and ensure
patient comfort as well as maximising the lifespan of the Prosthesis.
9
4.6.2
The fit of the Ocular Prosthesis will be assessed which may result in potential build ups,
resurfacing, cutting down or re-veining.
4.7 The fitting and manufacturing process shall include one or more of the following finished products:
5.
4.7.1
An Ocular Prosthesis for an eviscerated, enucleated or exenterated eye socket, with or
without an implant (Implant would be surgically placed by an Ophthalmologist)
4.7.2
A scleral shell Ocular Prosthesis for a phthysical, microphthalmic or blind, disfigured
globe.
4.7.3
Custom-made conformers for:
4.7.3.1
post-surgical eye sockets
4.7.3.2
globe shield for eyelid surgery
4.7.3.3
contracted eye socket expansion
4.7.3.4
congenital microphthalmos socket and/or eyelid expansion
4.7.3.5
congenital anophthalmos socket and/or eyelid expansion
4.7.3.6
template for prosthesis-to-implant motility-coupling device placement
procedure.
4.7.4
Enlargement (augmentation) of an Ocular Prosthesis.
4.7.5
Reduction of an Ocular Prosthesis.
4.7.6
Modification of Prosthesis for motility-coupling device(s).
Procedure Details
Explanation of RSV Point Allocation:
RSV Point
Relativity Service Value Points use consultation as base line. Each practice will use its own monetary
value for points.
Time
In minutes, approximate.
Skill
Score out of 5, (1 = min; 5 = max)
Skill and experience needed for any given task.
Risk
Score out of 5, (1 = min; 5 = max) Risk of repeating any given task.
Equipment
Score out of 5, (1 = min; 5 = max)
Expense of and/or number of pieces of equipment required to achieve any given task.
10
5.1 53015 Prosthetic Consultation
5.1.1
Purpose of Code
5.1.1.1
5.1.2
A patient new to the practice, or a patient who has not been seen by the
Ocularist for at least a period of three months.
Procedure:
5.1.2.1
A Prosthetic consultation shall include documenting one or several of the
following:
5.1.2.1.1
patient personal & contact details;
5.1.2.1.2
clinical history and observations, diagnosis, methodology and on-going
management;
5.1.2.1.3
informed consent to continue with proposed treatment plan from
patient or guardian.
5.1.3
Discussion of patient expectations include:
5.1.3.1
overall cosmesis achievable with fitting and manufacturing
5.1.3.2
overall cosmesis with current Ocular Prosthesis in situ
5.1.3.3
Ocular Prosthesis and socket care
5.1.3.4
psychological care or counselling
5.1.3.5
previous Ocular Prosthesis fitting where applicable
5.1.3.6
possible cosmetic surgery where applicable
5.1.3.7
cosmetic devices where applicable
5.1.3.8
discussion of future consultations through the process of Ocular Prosthesis
fitting and manufacturing
5.1.3.9
adaptation to Ocular Prosthesis and monocular vision or blindness
5.1.3.10
discussion of realistic costs involved, where possible
5.1.3.11
discussion of realistic life-span of the materials used in the manufacturing of an
Ocular Prosthesis
5.1.3.12
Examination of eye socket;
5.1.3.12.1.1
condition of the orbital or ocular tissue
5.1.3.12.1.2
condition of the socket structure, lids and fornices
5.1.3.12.1.3
presence of discharge, inflammation or irritation
5.1.3.12.1.4
implant mobility if applicable
11
5.1.3.12.1.5
possible surgical intervention
5.1.3.12.1.6
evaluation of achievable movement
5.1.4
Where necessary, discussion on Implant and other surgical options available to the
particular patient, where applicable showing implants, mobility peg and coupling
systems.
5.1.5
Where necessary, refer to Ophthalmologist; Plastic & Reconstructive Surgeon;
Optometrist; Psychologist; Psychiatrist; Maxillofacial Surgeon; parent or guardian.
5.1.6
Ocular Prosthetic Consultations can include photography of any one or several of the
above examinations.
5.1.7
Discussion on realistic results achievable and all options available.
RSV Points
Skill
Time
Risk
Equipment
100
5
60 minutes
2
3
5.2 53115 Impression for all Ocular Prosthetics
5.2.1
Purpose of Code
5.2.1.1
5.2.2
to determine the shape and size of the socket
5.2.1.1.1
to create a positive replication of the missing volume for accurate,
three dimensional manufacture of the Ocular Prosthesis.
5.2.1.1.2
to determine position and angle of the motility/coupling peg
5.2.1.1.3
to determine if the shape of the socket has altered since the last
prosthesis was fitted
The socket shape can change for many reasons, some of which include;
5.2.2.1
Soft tissue changes
5.2.2.2
Scarring
5.2.2.3
Developmental growth
5.2.2.4
Fatty tissue absorption
5.2.2.5
Healing after surgery and/or trauma
12
5.2.3
5.2.2.6
Change in patients body weight
5.2.2.7
Implant migration
Procedure
5.2.3.1
The eye socket is inspected for globe or implant position and irregularities in
conjunctival tissue and lids. Abnormalities which must be addressed are
identified.
5.2.3.2
Various methods are used in taking of impression.
5.2.3.3
An appropriate impression shell or conforma is chosen or manufactured and
placed into the socket.
5.2.3.3.1
Impression material is placed in the shell and then placed into the
socket or over existing globe.
OR
5.2.3.3.2
The shell is placed into the eye socket and impression material is
introduced into the eye socket behind the shell using a syringe or
dental Silicon gun.
OR
5.2.3.3.3
Impression of socket over existing prosthesis for building up of
prosthesis or positioning of motility peg or the like.
5.2.3.4
When the impression material is set, the impression is removed from the
socket.
5.2.3.5
The impression is then invested in an investment medium in preparation for
replication.
5.2.3.6
Re-inspection of the socket is usual, and is needed to check that no impression
material is left behind.
RSV Points
Skill
Time
Risk
Equipment
403
5
90 minutes
5
3
5.3 53215 - Iris Colour
5.3.1
Purpose of Code
5.3.1.1
Patient’s iris is measured for correct iris & pupil and an appropriate button size,
shape and thickness is chosen.
13
5.3.2
Procedure
5.3.2.1
RSV Points
Skill
Time
Risk
Equipment
5.3.2.2
An iris button for an acrylic Ocular Prosthesis is either hand painted or drawn
on a suitable material compatible with the MMA scleral colour discussed
under procedure code 53415 - Manufacture of Ocular Prosthesis.
An iris button can be used ex stock, painted or drawn from the patient directly.
5.3.2.3
When painting with MMA, ventilation in the room must be adequate.
166
5
90 minutes
4
3
5.4 53315 - Model Fitting
5.4.1
5.4.2
Purpose of Code
5.4.1.1
A Prosthetic model is manufactured as a pre-cursor to the final fitting of the
Ocular Prosthesis.
5.4.1.2
A model is the initial version of the final Prosthesis. The model is therefore
more easily adapted and adjusted than a final Ocular Prosthesis.
5.4.1.3
A model may be required to be worn for a period of time for various reasons
including time to allow swelling of the socket to subside or for patient
adaptation.
Procedure
5.4.2.1
Model manufacture:
5.4.2.1.1
Replication of impression is done in the appropriate material for
models.
5.4.2.2
Model fitting includes:
5.4.2.2.1
Modification or shaping of model for comfort, socket shape
compatibility, best movement achievable, size, symmetry of face and
features, eye socket fornices and eye socket irregularities as well as
motility peg positioning where necessary.
RSV Points
Skill
Time
Risk
Equipment
922
5
180 minutes
5
4
14
5.5 53415 Prosthesis Manufacture & Moulding
5.5.1
Purpose of Code
5.5.1.1
5.5.2
The Ocular Prosthesis will be the final product
Procedure
5.5.2.1
The model indicating the pupil and iris positioning is then invested in a dental
investment medium for replication in a suitable flask depending on the
method of curing to be used.
5.5.2.2
When both sections of the mould are finalised, the flask is opened and the
prototype model is removed.
5.5.2.3
The iris button is placed in the predetermined location in the anterior section
of the mould.
5.5.2.4
Either half of the mould may be enlarged slightly by grinding or scraping; or a
shim-material may be placed between the mould halves if necessary.
5.5.2.5
The mould is cleaned, inspected and a dental separating medium is applied to
each side of the mould.
5.5.2.6
Scleral toned manufacturing polymer and monomer are mixed together in a
suitable container as per instructions of relevant manufacturer, and shading
appropriate to the patient’s sclera.
5.5.2.7
Once the scleral-toned mixture is ready, the iris button is placed in position and
the mould is packed with the scleral-toned material and closed with
pressure.
5.5.2.8
Manufacturer’s instructions are to be adhered to, including multi-level curing.
5.5.2.9
The moulding flask is then placed in one of the following;
5.5.2.9.1
The moulding flask is submerged in a water bath and processed in
accordance with Specification 12 of the American Dental Association.
If using materials requiring different processing times, manufacturer’s
directions and curing times are to be adhered to.
Specification 12 reads ‘ …in water at 73°C (+/- 1°C) for one and a half
hours and then brought to boiling point for a further half hour.
When the heating schedule has been completed, the flask shall be
cooled in air at 23°C (+/-10°C) for thirty minutes and then immersed in
water at 23°C (+/-10°C) for a further fifteen minutes.”
5.5.2.9.2
Microwave Ovens (times and power levels may vary depending on the
power rating and wattage and the ballast mass placed in the
microwave oven). The specific power of the microwave oven, its
15
model number, brand name as well as levels, curing times and ballast
mass shall be indicated on the Patient Records.
5.5.2.9.3
Alternate source of Polymerization Propagation. The chosen methods,
time and temperature shall be adhered to and all pertinent
information shall be indicated on the Patient Records.
5.5.2.10 All sources of Polymerization propagation are considered “Curing-units”.
5.5.2.11
All batch numbers and curing methods and times shall be indicated on the
Patient Records.
5.5.2.12 The mould is then released from pressure, mould sections
separated and Prosthesis removed from the mould, excess flashing ground away,
iris exposed to proper diameter and scleral area is readied for painting and veining.
5.5.2.13
After procedure code 54115 - veining, the mould is again inspected, repaired,
cleaned and a separating medium is applied to both sections.
5.5.2.14 The prosthesis is placed into the posterior section of the mould. Clear material polymer
and monomer are mixed at the same ratio of 3:1 and cured as before with Lot and
Code numbers recorded on the Patient Records. The mixture is then placed on the
anterior surface, the mould sections interfaced and closed. The pressurized
moulding flask is processed in the curing-unit as before.
Once cured, the prosthesis is released from the mould. Flashing and surface
irregularities are ground away. It is first polished with a coarse to gradually finer
gradients of polishing materials. See procedure code 54215 – Polishing.
RSV Points
Skill
Time
Risk
Equipment
1065
4
360 minutes
3
4
5.6 53515 Follow-up ( within 6 months )
5.6.1
Purpose of Code
5.6.1.1
RSV Points
Skill
Time
Risk
Equipment
A consultation appointment or check-up within the first six months after 53015
55
5
240 minutes
4
4
16
5.7 53615 Consultation away from Practice
5.7.1
Purpose of Code
5.7.1.1
5.7.2
Patient may be unable to attend consultation at the practice, or in need of the
Ocularist to accompany the patient to a fellow Professional’s consulting
room.
Procedure
5.7.2.1
If a consultation has to take place away from a registered practice or regular
satellite practice address. This may be in conjunction with an
Ophthalmologist or other specialist, at their practice rooms. (The satellite
practice address is accepted as a normal address)
5.7.2.2
Consultation as per procedure code 53015 – Consultation, but including
traveling time.
5.7.2.3
Travel costs may include AA rates from practice to consultation and back again.
RSV Points
Skill
Time
Risk
Equipment
188
5
240 minutes
1
1
5.8 53715 - Glass Eye, complete with Consultation and Fitting
5.8.1
RSV Points
Skill
Time
Risk
Equipment
Purpose of code
5.8.1.1
This form of Ocular Prosthesis is performed predominantly by Ocularists
trained abroad and in accordance with their standards.
5.8.1.2
This code includes the completed Ocular Prosthesis including consultations,
manufacture and fittings.
1150
5
120 minutes
5
3
5.9 53815 Drill Ball and Socket (pegging to coral)
5.9.1
Purpose of Code
17
5.9.2
5.9.1.1
Coupling of the Prosthesis to the peg can only be done on acrylic Ocular
Prostheses and will result in maximum movement being transferred from the
implant to the Prosthesis.
5.9.1.2
The coupling may also be used to hold the Prosthesis in place, and prevent the
Prosthesis from causing lower lid sagging or soft tissue changes.
Procedure
5.9.2.1
Drilling of Ocular Prosthesis for peg coupling to Ocular Prosthesis. Various
methods are used for coupling position determination including;
5.9.2.1.1
Impression of eye socket either on back of Prosthesis or with standard
shells.
5.9.2.1.2
Pilot hole drilling used with temporary small headed peg
5.9.2.1.3
Manual judgement by Ocularist
RSV Points
Skill
Time
Risk
Equipment
162
5
120 minutes
5
3
5.10 53915 - Trimming and Re-shaping
5.10.1
Purpose of Code
5.10.1.1
5.10.2
Procedure
5.10.2.1
RSV Points
Skill
Time
Risk
Equipment
Instead of making a new Prosthesis, costs can be saved by adjusting an
existing Ocular Prosthesis.
Adjustments are made to an existing Prosthesis whereby cutting of the Ocular
Prosthesis will allow for better fit or cosmesis, provided that the material is
viable.
81
5
120 minutes
5
3
18
5.11 54015 - Build-up
5.11.1
Purpose of Code
5.11.1.1
5.11.2
As with procedure code 53915 – Trimming & Reshaping, costs are saved by
working on an existing Ocular Prosthesis.
Procedure
5.11.2.1
To perform an alteration to an existing Ocular Prosthesis usually using dental
wax to build-up the shape and then adding to the Ocular Prosthesis in the
compatible material, provided that the material of the existing Ocular
Prosthesis is still viable.
5.11.2.2
All factory specifications of the materials used, as described above, must be
strictly adhered to.
RSV Points
Skill
Time
Risk
Equipment
239
5
360 minutes
5
4
5.12 54115 - Veining
5.12.1
Purpose of Code
5.12.1.1
5.12.2
RSV Points
Skill
Time
Risk
Equipment
To replicate the veins in the sighted eye
Procedure
5.12.2.1
Replication of veins and scleral shading is matched to the patient’s sighted eye
or sample, where necessary.
5.12.2.2
Iris tones are enhanced, or applied to anterior surface along with the scleral
tones and veins.
5.12.2.3
Artwork is then cured onto the Prosthesis as per the appropriate curing
methods.
113
5
240 minutes
4
3
19
5.13 54215 - Polishing
5.13.1
5.13.2
Purpose of Code
5.13.1.1
To produce a perfect surface on the Prosthesis for maximum comfort.
5.13.1.2
To minimize irritation to eyelids.
5.13.1.3
As a final procedure after procedure code 53415 - Manufacture of an Ocular
Prosthesis
Procedure
5.13.2.1
Final polish of an Ocular Prosthesis or polishing on a yearly basis, is performed
in order to maintain the surface of the Prosthesis.
5.13.2.2
A final wet and/or dry high gloss is applied after inspection of all surfaces is
complete. There should be no visible defects when examined with a 3x loupe
or magnifier. The Prosthesis is now ready for disinfection and dispensed to
the patient.
5.13.2.3
Minor surface reduction may be made during the fitting process, with
subsequent re-polishing of all surfaces, before the final fitting of the
Prosthesis. Before final fitting, re-inspection under a 3x loupe or magnifier is
required.
RSV Points
Skill
Time
Risk
Equipment
50
4
60 minutes
2
3
5.14 54315 Materials for Custom Eye
5.14.1
RSV Points
Skill
Time
Risk
Equipment
Purpose of Code
5.14.1.1
Factory specifications and instructions will be strictly adhered to.
5.14.1.2
Materials will vary from practice to practice, but only socket approved dental
and ophthalmic supplies may be used.
5.14.1.3
Records of batch numbers of materials used are to be recorded on patient’s
record file.
314
2
15 minutes
5
2
20
5.15 54415 - Stock Eye
5.15.1
Purpose of Code
5.15.1.1
5.15.2
Procedure
5.15.2.1
RSV Points
Skill
Time
Risk
Equipment
Reducing costs to patients.
Limited colour and shape choices are available and the properties of these
Ocular Prostheses shall be clearly addressed with the patient where a stock
Prosthesis is fitted.
224
4
120 minutes
2
3
5.16 54515 - Prosthetic Haptic Lens
5.16.1
RSV Points
Skill
Time
Risk
Equipment
Purpose of Code
5.16.1.1
This surcharge may be charged when working on a patient with a phthysical
eye.
5.16.1.2
Increased risks include;
5.16.1.2.1
Additional time taken for appointments
5.16.1.2.2
Additional time taken for fitting and manufacture.
5.16.1.2.3
Increased risk of remaking due fitting challenges and therefore to
discomfort and fit.
5.16.1.2.4
Increased risk of breakage due to the fragility of the Prosthesis during
any stage of the manufacturing process.
490
5
180 minutes
5
3
21
5.17 54615 - Motility / Coupling Peg
5.17.1
Purpose of Code
5.17.1.1
5.17.2
The purpose of a motility/coupling peg is to transfer movement from the
implant to the Prosthesis.
Procedure
5.17.2.1
RSV Points
Skill
Time
Risk
Equipment
Supply of a Titanium or other peg for use with the implant specific coupling
system administered by the Surgeon.
Relevant to input cost
2
30 minutes
1
1
5.18 54715 - Conforma Supply and Fit
5.18.1
Purpose of Code
5.18.1.1
RSV Points
Skill
Time
Risk
Equipment
An ex-stock model for use in or after surgery as a temporary socket retention
tool whilst socket is healing or while patient is not yet ready for fitting of a
final Prosthesis.
130
3
60 minutes
1
2
5.19 54815 - Conforma Supply Only
5.19.1
Purpose of Code
5.19.1.1
RSV Points
Skill
Time
Risk
Equipment
Conforma supplied to Doctor for use in or after surgery as procedure code
54915 – Surcharge, Children 5 years and under.
81
3
15 minutes
1
1
22
5.20 54915 - Surcharge - Children under 5 years of age
5.20.1
Purpose of Code
5.20.1.1
This surcharge may be necessary when working on a young patient as the
fitting is more time-consuming on the patient who is not yet able to cooperate or fully understand the importance of the work done to achieve a
satisfactory end result.
5.20.1.2
Increased risks include:
5.20.1.2.1
Additional time taken for appointments.
5.20.1.2.2
Additional time taken for manufacture.
5.20.1.2.3
Increased risks of re-making due to lack of co-operation.
RSV Points
Skill
Time
Risk
Equipment
495
5
240 minutes
5
1
5.21 55015 Assist in Theatre – per 30 minutes
5.21.1
Purpose of Code
5.21.1.1
May include:
5.21.1.1.1
Discussion with Ophthalmologist, Reconstructive Surgeon,
Anaesthetist and/or theatre staff, patient and the like.
5.21.1.1.2
Assistance requested by Doctor, usually in the fitting and shaping of
models for reconstructive purposes and/or
5.21.1.1.3
Taking of impression for manufacture of model in patients who are
not easily able to have this done in practice and/or
5.21.1.1.4
Patients who require model fitting for reconstructive purposes.
5.21.1.1.5
Post procedure consultation in ward with patient and/or parent or
legal guardian.
5.21.1.2
Travel costs at AA rates may be charged for travel from practice to theatre and
return.
23
RSV Points
Skill
Time
Risk
Equipment
102
5
180 minutes
1
2
5.22 56000 - Complete Eye
5.22.1
Purpose of Code
5.22.1.1
5.22.2
Is to provide one global price of all manufacturing and fitting costs including six
months aftercare.
Procedure
5.22.2.1
The Complete Eye code is a combination of the following codes:
53015 Prosthetic Consultation
53115 Impression for all Ocular Prosthetics
53215 Iris Colour
53315 Model Fitting
53415 Prosthesis Manufacture and Moulding
53515 Follow-Up (within 6 months)
54115 Veining
54215 Polishing
54315 Materials for Custom Eye
5.22.2.2
RSV Points
Skill
Time
Risk
Equipment
Where appropriate procedure code 54515 - Prosthetic Haptic Lens and/or
procedure code 54915 - Surcharge - Children under 5 Years of Age will be
charged in addition to the Complete Eye Code.
3136
5
1335 minutes
5
5
24
6.
SAOA – Procedure codes Series 5000/Ocular Prosthetics
South African Optometric Association Coding Structure– As per Optical Assistants Publication – updated
annually
Fees inclusive of 14% V.A.T
Series 5000 – Ocular Prosthetics
25