Surgery for Optometry
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Transcript of Surgery for Optometry
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Surgery for Surgery for OptometryOptometry
Dwight Thibodeaux, ODDwight Thibodeaux, OD
Santa Fe, NMSanta Fe, NM
[email protected]@msn.com
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For reimbursement For reimbursement purposes, the AMA defines purposes, the AMA defines
surgerysurgery
Removing an eyelash is Removing an eyelash is ““surgerysurgery”” CPT Codes for surgeryCPT Codes for surgery
Eye/Eyelids 6xxxxEye/Eyelids 6xxxx Skin 1xxxxSkin 1xxxx
Latin root-Latin root-””by handby hand””
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20072007
NM passed statute that expanded NM passed statute that expanded and codified list of approved and codified list of approved proceduresprocedures
Commercial insurance--Good Commercial insurance--Good payment turn-aroundpayment turn-around
Medicare/Trailblazer slow payment--Medicare/Trailblazer slow payment--politicalpolitical
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Why not surgery?Why not surgery?
ExperienceExperience Space, staffSpace, staff TimeTime Equipment ROIEquipment ROI Risk aversionRisk aversion
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Basic Supplies and Basic Supplies and InstrumentsInstruments
Blades, handles, clampsBlades, handles, clamps Gauze pads, tapeGauze pads, tape Syringes, needlesSyringes, needles AnestheticsAnesthetics Surgical scissors, forcepsSurgical scissors, forceps Sterilization methodSterilization method GlovesGloves Sharps and biohazard containerSharps and biohazard container
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RF Ellman UnitRF Ellman Unit
Permanent epilationPermanent epilation PunctoplastyPunctoplasty Lesion removal and cauterizationLesion removal and cauterization Costly for small officesCostly for small offices $3-5,000, need lots of procedures to $3-5,000, need lots of procedures to
pay off investment-ROIpay off investment-ROI
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Develop a card system Develop a card system for procedures specific for procedures specific
surgical tray.surgical tray.At the top of each At the top of each
card……card…… Physician orders form and procedure Physician orders form and procedure
reportreport Informed Consent formInformed Consent form Instruments and materials for Instruments and materials for
procedureprocedure
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Chalazion inject or I/CChalazion inject or I/C
Hot compresses/massageHot compresses/massage Age of lesionAge of lesion Skin pigmentationSkin pigmentation Pediatric patientPediatric patient
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Debridement and Anterior Debridement and Anterior Stromal Puncture for RCEStromal Puncture for RCE
Needed for recurrent corneal Needed for recurrent corneal erosionserosions
Previous corneal injury or corneal Previous corneal injury or corneal dystrophydystrophy
Non-central areasNon-central areas Alternative—PTK, hyperosmoticsAlternative—PTK, hyperosmotics
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Lumps and BumpsLumps and Bumps
+/- biopsy+/- biopsy LidsLids AdnexaAdnexa ConjunctivaConjunctiva Papillomas, moles, hemangiomasPapillomas, moles, hemangiomas Sehorrehic keratosisSehorrehic keratosis Actinic keratosisActinic keratosis
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PunctoplastyPunctoplasty
Snip procedureSnip procedure Cannicular closureCannicular closure Know indicationsKnow indications
EpiphoraEpiphora Dry eyeDry eye
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Professional LiabilityProfessional Liability
Doctor needs to review policy, AOA Doctor needs to review policy, AOA recommendation a good choice recommendation a good choice (Marsh)(Marsh)
Informed consentInformed consent Schedule surgery on separate day Schedule surgery on separate day
to give patient a chance to consider to give patient a chance to consider risksrisks
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What is…What is…
Infiltrative anesthesia?Infiltrative anesthesia? Nerve block?Nerve block? Field block?Field block?
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Why use epinephrine with Why use epinephrine with xylocaine for injection?xylocaine for injection?
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Where on the body should Where on the body should you never use Epi for you never use Epi for
injection?injection?
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What cosmetic eye/adnexal What cosmetic eye/adnexal sx procedures are approved sx procedures are approved
for OD use in NM?for OD use in NM?
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How do you determine what How do you determine what conditions are covered by conditions are covered by insurance for any given insurance for any given
procedure?procedure?
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When do we need When do we need informed consent? When informed consent? When
not?not?
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What are the 3 most What are the 3 most common items to list as common items to list as potential complications potential complications in informed consent for in informed consent for minor sx procedures?minor sx procedures?
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Why would one use a Why would one use a blend of xylocaine and blend of xylocaine and
marcaine for a marcaine for a procedure?procedure?
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What is a vasovagal What is a vasovagal reaction? What is reaction? What is
syncope?syncope?
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Define universal Define universal precautionsprecautions
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Can an OD prescribe Can an OD prescribe tranquilizers?tranquilizers?
When?When?
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Relative Relative contraindications for contraindications for removal of vascular removal of vascular
lesions?lesions?
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Clinical CaseClinical Case
25 yo Native American with 25 yo Native American with chalazion…..chalazion…..
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Why should ODWhy should OD’’s s embrace our new law?embrace our new law?
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Q&A and Handout Q&A and Handout ReviewReview
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Thank you!Thank you!