Article

CLINICAL: Contact Lenses

Answer the Call

Consider adding specialty contact lens care to the practice

During these challenging times, many O.D.s are evolving in the way they are providing care. Specifically, telemedicine is being utilized more; but, I hope optometrists also are evaluating ways to continue to help patients who need hands-on care.

Those who have unique visual challenges, such as specialty contact lens wearers, need in-person attention that often requires more chair time and preparation. This additional time includes having the proper fit sets and understanding proper billing and coding prior to these patients presenting to the office. Also, providing this service amid the COVID-19 pandemic has its own set of requirements: the triage of phone systems and O.D. office hours for such services, as examples.

Here’s a look at a recent related case and the steps we took to ensure the patient received the services she needed.

CASE IN POINT

A 40-year-old custom toric specialty contact lens wearer with a prescription around -17.00 D of myopia and 3.00 D of astigmatism with a history of a retinal tear requested to be seen during this time of social distancing and a state-wide standing stay-at-home request. Specifically, she contacted the practice reporting a new floater and, therefore, a concern there may be a new tear. Additionally, she said her vision had changed some, and she would need to order more contact lenses.

The patient’s history included a retinal tear.
Images courtesy of Dr. Jason R. Miller.

INFRASTRUCTURE

Before discussing how I diagnosed and managed this patient, my practice put these protocols in place to see patients in person:

We have maintained one doctor and two staff members, so far. We are answering the phones, seeing urgent care patients and taking orders for any goods (contact lenses, vitamins, etc.). Also, any patients arriving at the office for an emergency visit are scheduled far apart, so they are not in the practice at the same time.

DIAGNOSIS

The patient’s exam revealed a new floater but, thankfully, no retinal tears were evident in either eye, preventing a visit to the emergency room. (Read more about promoting urgent eye care services in last month’s column: bit.ly/OMAprilCL .) I was able to double check my findings via retinal photos. The patient’s prescription had shifted slightly, so I adjusted her custom toric lenses.

BILLING AND CODING

Many vision plans have coverage for visually or medically necessary contact lenses. O.D.s should consult their contracts and understand the requirements, so they know how to bill and which diagnoses are covered.

Many vision plans will reimburse a percentage of the optometrist’s usual and customary fees for both contact lens professional services and material fees. (Please note, O.D.s cannot bill for more than the usual and customary fee.) Here are some examples of diagnoses that are approved for these services. (This is not a complete list and should be confirmed with specific payers.)

  • Aphakia
  • Nystagmus
  • Keratoconus
  • Corneal transplant
  • Corneal dystrophies
  • Anisometropia, greater than or equal to 3.00 D difference in any meridian, based on the spectacle prescription
  • High ametropia, usually greater than or equal to ±10.00 D in either eye in any meridian based on the spectacle prescription, but this does vary by payer.
  • Irregular astigmatism

NEW NORMAL

Let’s take the time during this pause in regular practice to consider adding specialty contact lens care or developing a focus on those who have unique visual challenges and symptoms. OM