AE March/April 2018 Vol 27 No 2 - 42

SPECIALTY PRACTICE // OCULAR SURFACE DISEASE

REIMBURSEMENT
CONSIDERATIONS
FOR THE EVALUATION AND MANAGEMENT OF DRY EYE
Kevin J. Corcoran, COE, CPC, CPMA, FNAO, and Sara B. Rapuano, MBA, CPS, COE

E

valuation and management
of dry eye has received
an increasing amount of
attention over the past few
years. Ophthalmologists and
optometrists focus on the
implications of dry eye with
respect to quality of life, but also on
the impact that dry eye can have on
their patients' cataract and refractive surgical outcomes. As more attention has focused on this disease,
the diagnostic options available to
physicians have expanded significantly. These diagnostic tools can
help to determine whether the
patient has evaporative dry eye
(meibomian gland dysfunction) or
aqueous deficient dry eye (reduced
tear volume) or, more commonly,
a combination of the two. This
information can help inform the
treatment plan.

DIAGNOSTIC SERVICES
The Tear Film and Ocular Surface
Society (TFOS) Dry Eye WorkShop (DEWS) II study published
in 2017 reviews many of the
modalities to evaluate patients with
dry eye symptoms.1 Options range
from patient questionnaires to
performance of tear breakup time,
tear osmolarity testing, inflammatory marker testing, ocular surface
staining with lissamine green and

42

AE // Mar/Apr 18

fluorescein dyes, and meibomian
gland function testing.
There are financial implications
for each option. Some of these
services are included in an eye
examination, while others are billed
separately. Some are covered by
insurance while others are considered investigational and noncovered. Here is a list of the diagnostics
included in an eye examination:
* Functional questionnaires such
as the Ocular Surface Disease
Index (OSDI), or Standard Patient Evaluation of Eye Dryness
(SPEED)
* Tear breakup time (TBUT)
* Lissamine green conjunctival staining
* Fluorescein corneal staining
CLIA-waived in-office laboratory
tests are reimbursed per eye in the
$15-$25 range and include
* 82785-IgE microassay-allergy test
* 83516-MMP-9 immunoassay-inflammation indicator
* 83520-Lactoferrin microassay-protein dry eye marker
* 83861-Tear osmolarity-
measures the content of salt in
the tears
Additional office-based tests
that may be billed but that are
not universally covered by insurance include

* 0330T-Tear film imaging, unilateral or bilateral, with interpretation
and report (Lipiview II or the
Oculus Keratograph 5 TF-Scan)
* 92285-External photography
and meibomian gland imaging
(Lipiview II or the Oculus Keratograph 5 Meibo-Scan)
TREATMENT
As with diagnostic testing, the
treatment options for dry eye are
more numerous and have varying
insurance coverage and payment.
First-line treatments that patients
purchase include OTC tears, gels,
and ointments; vitamin supplements; eyelid scrubs (OCuSOFT,
EyeScrub, SteriLid); and warm
compresses (MediBeads). Prescription medications usually covered by
pharmacy plans include cyclosporine (Restasis); lifitegrast (Xiidra);
steroids (loteprednol etabonate,
prednisolone acetate); and cellulose
insert (Lacricert). Punctal plugs and
punctal cautery, when medically
necessary, are covered by health
plans. In severe cases, amniotic
membrane may be used to cover
the eye after dry eye has damaged
the corneal epithelium to facilitate
healing and return the ocular surface to a normal state.
Autologous serum eye drops
(SEDs) are made from a patient's



Table of Contents for the Digital Edition of AE March/April 2018 Vol 27 No 2

How We Can Successfully Lead
Advanced Administration: Administrator Success Factors—Needing a Tune-Up Is Expected
Advice for New Administrators: Introducing the Administrator Beginners Circle—The Go-To Resource for New Administrators
Business Operations: Some Things to Know About Professional Liability Insurance
Customer Care: Making a Diffi cult Journey A Little Easier
Fast Practice: Breaking Down Practice Cliques
Human Resources: Recruiting Strategies for Ophthalmology—Where to Search for New Physicians
InfoTech: Cloud Computing— Storms or Blue Skies?
Reimbursement: Embracing Change to Thrive in an Evolving Reimbursement World
Technicians: Creating a “Feeder Program” to Staff Your Clinic
Washington Watch: MIPS in 2018—Key Changes for Ophthalmic Practices
Taking Your Practice to the Top
Use Podcasts to Increase Practice Visibility—and Thrive
Trailblazing— How to Implement Career Pathing in Your Practice
Ocular Surface Disease: Reimbursement Considerations for the Evaluation and Management of Dry Eye
Retina: Should Retinal Specialists Be Integrated Into a Multispecialty Practice?
Asked and Answered
ASOA News
Bookshelf: Off Balance On Purpose: Embrace Uncertainty and Create a Life You Love
COE Corner: Preparing for the COE Exam – Keep Your Eye on the Prize
Focus on a Practice: Ohio Valley Eye Physicians & Surgeons, PLLC, on Operating a Practice in Two States
Gamechanger: Karen Bachman, COE, COMT, OCS, ROUB
Advertisers’ Index
Peer to Peer: What’s Your Favorite Technique for Holding a Productive Staff Meeting?
AE March/April 2018 Vol 27 No 2 - Cover1
AE March/April 2018 Vol 27 No 2 - Cover2
AE March/April 2018 Vol 27 No 2 - 1
AE March/April 2018 Vol 27 No 2 - 2
AE March/April 2018 Vol 27 No 2 - 3
AE March/April 2018 Vol 27 No 2 - 4
AE March/April 2018 Vol 27 No 2 - How We Can Successfully Lead
AE March/April 2018 Vol 27 No 2 - Advanced Administration: Administrator Success Factors—Needing a Tune-Up Is Expected
AE March/April 2018 Vol 27 No 2 - 7
AE March/April 2018 Vol 27 No 2 - Advice for New Administrators: Introducing the Administrator Beginners Circle—The Go-To Resource for New Administrators
AE March/April 2018 Vol 27 No 2 - 9
AE March/April 2018 Vol 27 No 2 - Business Operations: Some Things to Know About Professional Liability Insurance
AE March/April 2018 Vol 27 No 2 - 11
AE March/April 2018 Vol 27 No 2 - Customer Care: Making a Diffi cult Journey A Little Easier
AE March/April 2018 Vol 27 No 2 - 13
AE March/April 2018 Vol 27 No 2 - Fast Practice: Breaking Down Practice Cliques
AE March/April 2018 Vol 27 No 2 - 15
AE March/April 2018 Vol 27 No 2 - Human Resources: Recruiting Strategies for Ophthalmology—Where to Search for New Physicians
AE March/April 2018 Vol 27 No 2 - 17
AE March/April 2018 Vol 27 No 2 - InfoTech: Cloud Computing— Storms or Blue Skies?
AE March/April 2018 Vol 27 No 2 - 19
AE March/April 2018 Vol 27 No 2 - Reimbursement: Embracing Change to Thrive in an Evolving Reimbursement World
AE March/April 2018 Vol 27 No 2 - 21
AE March/April 2018 Vol 27 No 2 - Technicians: Creating a “Feeder Program” to Staff Your Clinic
AE March/April 2018 Vol 27 No 2 - 23
AE March/April 2018 Vol 27 No 2 - Washington Watch: MIPS in 2018—Key Changes for Ophthalmic Practices
AE March/April 2018 Vol 27 No 2 - 25
AE March/April 2018 Vol 27 No 2 - Taking Your Practice to the Top
AE March/April 2018 Vol 27 No 2 - 27
AE March/April 2018 Vol 27 No 2 - 28
AE March/April 2018 Vol 27 No 2 - 29
AE March/April 2018 Vol 27 No 2 - 30
AE March/April 2018 Vol 27 No 2 - 31
AE March/April 2018 Vol 27 No 2 - 32
AE March/April 2018 Vol 27 No 2 - 33
AE March/April 2018 Vol 27 No 2 - Use Podcasts to Increase Practice Visibility—and Thrive
AE March/April 2018 Vol 27 No 2 - 35
AE March/April 2018 Vol 27 No 2 - 36
AE March/April 2018 Vol 27 No 2 - 37
AE March/April 2018 Vol 27 No 2 - Trailblazing— How to Implement Career Pathing in Your Practice
AE March/April 2018 Vol 27 No 2 - 39
AE March/April 2018 Vol 27 No 2 - 40
AE March/April 2018 Vol 27 No 2 - 41
AE March/April 2018 Vol 27 No 2 - Ocular Surface Disease: Reimbursement Considerations for the Evaluation and Management of Dry Eye
AE March/April 2018 Vol 27 No 2 - 43
AE March/April 2018 Vol 27 No 2 - Retina: Should Retinal Specialists Be Integrated Into a Multispecialty Practice?
AE March/April 2018 Vol 27 No 2 - 45
AE March/April 2018 Vol 27 No 2 - Asked and Answered
AE March/April 2018 Vol 27 No 2 - 47
AE March/April 2018 Vol 27 No 2 - ASOA News
AE March/April 2018 Vol 27 No 2 - 49
AE March/April 2018 Vol 27 No 2 - Bookshelf: Off Balance On Purpose: Embrace Uncertainty and Create a Life You Love
AE March/April 2018 Vol 27 No 2 - 51
AE March/April 2018 Vol 27 No 2 - COE Corner: Preparing for the COE Exam – Keep Your Eye on the Prize
AE March/April 2018 Vol 27 No 2 - 53
AE March/April 2018 Vol 27 No 2 - Focus on a Practice: Ohio Valley Eye Physicians & Surgeons, PLLC, on Operating a Practice in Two States
AE March/April 2018 Vol 27 No 2 - 55
AE March/April 2018 Vol 27 No 2 - Gamechanger: Karen Bachman, COE, COMT, OCS, ROUB
AE March/April 2018 Vol 27 No 2 - 57
AE March/April 2018 Vol 27 No 2 - Advertisers’ Index
AE March/April 2018 Vol 27 No 2 - 59
AE March/April 2018 Vol 27 No 2 - Peer to Peer: What’s Your Favorite Technique for Holding a Productive Staff Meeting?
AE March/April 2018 Vol 27 No 2 - Cover3
AE March/April 2018 Vol 27 No 2 - Cover4
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