Surgery for Surgery for OptometryOptometry

Dwight Thibodeaux, ODDwight Thibodeaux, OD

Santa Fe, NMSanta Fe, NM

drthib@msn.comdrthib@msn.com

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””

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

Why not surgery?Why not surgery?

ExperienceExperience Space, staffSpace, staff TimeTime Equipment ROIEquipment ROI Risk aversionRisk aversion

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

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

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

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

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

Lumps and BumpsLumps and Bumps

+/- biopsy+/- biopsy LidsLids AdnexaAdnexa ConjunctivaConjunctiva Papillomas, moles, hemangiomasPapillomas, moles, hemangiomas Sehorrehic keratosisSehorrehic keratosis Actinic keratosisActinic keratosis

PunctoplastyPunctoplasty

Snip procedureSnip procedure Cannicular closureCannicular closure Know indicationsKnow indications

EpiphoraEpiphora Dry eyeDry eye

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

What is…What is…

Infiltrative anesthesia?Infiltrative anesthesia? Nerve block?Nerve block? Field block?Field block?

Why use epinephrine with Why use epinephrine with xylocaine for injection?xylocaine for injection?

Where on the body should Where on the body should you never use Epi for you never use Epi for

injection?injection?

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?

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?

When do we need When do we need informed consent? When informed consent? When

not?not?

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?

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?

What is a vasovagal What is a vasovagal reaction? What is reaction? What is

syncope?syncope?

Define universal Define universal precautionsprecautions

Can an OD prescribe Can an OD prescribe tranquilizers?tranquilizers?

When?When?

Relative Relative contraindications for contraindications for removal of vascular removal of vascular

lesions?lesions?

Clinical CaseClinical Case

25 yo Native American with 25 yo Native American with chalazion…..chalazion…..

Why should ODWhy should OD’’s s embrace our new law?embrace our new law?

Q&A and Handout Q&A and Handout ReviewReview

Thank you!Thank you!