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 patientSearch 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 EMRUse 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
ED ED
04/19/`2011 04/19/2011
7.52
7.55
-2.00
-2.00
9.2
9.2
Boston XO
Boston XO
x
Smith, Joe
x
xx
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 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
Glo
bal
Non-Global
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