CLINICAL

  contact lenses

Therapeutic Contact Lenses

Treatment options for patients who have OSD

JASON R. MILLER, O.D., M.B.A., F.A.A.O.

T.K., a 51-year-old Caucasian male, presented with a corneal abrasion OS near the flap line from LASIK surgery, which occurred about 10 years ago (see Figure 1). Initial treatment included a bandage contact lens along with concomitant antibiotic medication treatment for seven days. After one week, the wound was not healing, and his pain and inflammation had not improved. To promote healing, I inserted a Prokera (Bio-Tissue) amniotic membrane. Five days later at his next recheck, the membrane was removed, revealing dramatic pain reduction and wound healing.

Figure 1: Patients who present with OSD, such as the corneal abrasion shown here, may benefit from therapeutic contact lenses to promote healing.

Ocular surface disease (OSD) is something many practitioners see at ever-increasing rates. Like any disease process, OSD has varying levels of severity and, thus, requires varying levels of treatment.

It is important to be prepared for all levels of severity, as a case presentation may be more severe, or the patient may not be healing as expected.

Here, I highlight two of the most common uses of therapeutic contact lenses and when to use them, as well as the proper billing codes for each.

Bandage contact lenses

When a patient presents with a corneal abrasion, a bandage contact lens is typically used to shield the highly enervated corneal surface from the constant mechanical irritation of the eyelids. This is important to help ease the pain while the cornea heals itself.

• Coding: The proper CPT code for this procedure is 92071, which is defined by AoaCodingToday.com as the “fitting of a contact lens for the treatment of ocular surface disease.” Make sure to indicate the specific eye (RT or LT) because this code is unilateral in nature.

• Reimbursement: The national payment amount by CMS for this procedure is $38.69, but be sure to check your specific local coverage determination (LCD) to determine the exact payment.

Biological corneal bandages

When the ocular surface is not healing properly or the condition presents with more severity, consider employing biological corneal bandages.

These bandages are an FDA Class II medical device made up of thermoplastic rings that hold the amniotic membrane in place and are designed to promote wound healing.

• Coding: The proper CPT code for this procedure is 65778, which is defined by Aoa.CodingToday.com as “placement of amniotic membrane on the ocular surface for wound-healing; self-retaining.”

• Reimbursement: Reimbursement for the supply is included with payment for the procedure. The national payment for 65778 by CMS for this procedure is $1,388.85, but it is important to check your specific LCD to determine the exact payment.

Case conclusion

After removing the membrane, T.K. continued preservative-free artificial tears eye drops for a period of time. The corneal abrasion fully healed, and the amniotic membrane was critical to improving that process. OM

DR. MILLER IS A PARTNER IN A PRIVATE PRACTICE IN POWELL, OHIO, AND IS AN ADJUNCT FACULTY MEMBER FOR THE OHIO STATE UNIVERSITY COLLEGE OF OPTOMETRY. SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.