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