Optometrists in New Mexico are now allowed to perform certain surgical procedures according to a statute passed in 2007. These include procedures like chalazion removal, punctal plug placement, and lesion removal. Performing surgery requires additional supplies, equipment, training and risks that many optometrists have not pursued due to the investment required. However, embracing these new surgical privileges could expand treatment options for patients and reimbursement opportunities for optometrists' practices. This presentation reviewed the definitions and coding of eye surgery, considerations for pursuing it, basic supplies and instruments needed, example procedures that could be performed, informed consent requirements, and liability issues.

1. Surgery for OptometrySurgery for Optometry
Dwight Thibodeaux, ODDwight Thibodeaux, OD
Santa Fe, NMSanta Fe, NM
drthib@msn.comdrthib@msn.com

2. For reimbursement purposes, theFor reimbursement purposes, the
AMA defines surgeryAMA defines surgery
 Removing an eyelash isRemoving 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””

3. 20072007
 NM passed statute that expanded and codifiedNM passed statute that expanded and codified
list of approved procedureslist of approved procedures
 Commercial insurance--Good payment turn-Commercial insurance--Good payment turn-
aroundaround
 Medicare/Trailblazer slow payment--politicalMedicare/Trailblazer slow payment--political

4. Why not surgery?Why not surgery?
 ExperienceExperience
 Space, staffSpace, staff
 TimeTime
 Equipment ROIEquipment ROI
 Risk aversionRisk aversion

5. Basic Supplies and InstrumentsBasic Supplies and Instruments
 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

8. 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 pay off$3-5,000, need lots of procedures to pay off
investment-ROIinvestment-ROI

10. Develop a card system forDevelop a card system for
procedures specific surgical tray.procedures specific surgical tray.
At the top of each card……At the top of each card……
 Physician orders form and procedure reportPhysician orders form and procedure report
 Informed Consent formInformed Consent form
 Instruments and materials for procedureInstruments and materials for procedure

11. 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

13. Debridement and Anterior StromalDebridement and Anterior Stromal
Puncture for RCEPuncture for RCE
 Needed for recurrent corneal erosionsNeeded for recurrent corneal erosions
 Previous corneal injury or corneal dystrophyPrevious corneal injury or corneal dystrophy
 Non-central areasNon-central areas
 Alternative—PTK, hyperosmoticsAlternative—PTK, hyperosmotics

14. Lumps and BumpsLumps and Bumps
 +/- biopsy+/- biopsy
 LidsLids
 AdnexaAdnexa
 ConjunctivaConjunctiva
 Papillomas, moles, hemangiomasPapillomas, moles, hemangiomas
 Sehorrehic keratosisSehorrehic keratosis
 Actinic keratosisActinic keratosis

18. PunctoplastyPunctoplasty
 Snip procedureSnip procedure
 Cannicular closureCannicular closure
 Know indicationsKnow indications
 EpiphoraEpiphora
 Dry eyeDry eye

20. Professional LiabilityProfessional Liability
 Doctor needs to review policy, AOADoctor needs to review policy, AOA
recommendation a good choice (Marsh)recommendation a good choice (Marsh)
 Informed consentInformed consent
 Schedule surgery on separate day to giveSchedule surgery on separate day to give
patient a chance to consider riskspatient a chance to consider risks

21. What is…What is…
 Infiltrative anesthesia?Infiltrative anesthesia?
 Nerve block?Nerve block?
 Field block?Field block?

22. Why use epinephrine with xylocaineWhy use epinephrine with xylocaine
for injection?for injection?

23. Where on the body should you neverWhere on the body should you never
use Epi for injection?use Epi for injection?

24. What cosmetic eye/adnexal sxWhat cosmetic eye/adnexal sx
procedures are approved for OD useprocedures are approved for OD use
in NM?in NM?

25. How do you determine whatHow do you determine what
conditions are covered by insuranceconditions are covered by insurance
for any given procedure?for any given procedure?

26. When do we need informedWhen do we need informed
consent? When not?consent? When not?

27. What are the 3 most commonWhat are the 3 most common
items to list as potentialitems to list as potential
complications in informedcomplications in informed
consent for minor sx procedures?consent for minor sx procedures?

28. Why would one use a blend ofWhy would one use a blend of
xylocaine and marcaine for axylocaine and marcaine for a
procedure?procedure?

29. What is a vasovagal reaction?What is a vasovagal reaction?
What is syncope?What is syncope?

30. Define universal precautionsDefine universal precautions

31. Can an OD prescribeCan an OD prescribe
tranquilizers?tranquilizers?
 When?When?

32. Relative contraindications forRelative contraindications for
removal of vascular lesions?removal of vascular lesions?

33. Clinical CaseClinical Case
 25 yo Native American with chalazion…..25 yo Native American with chalazion…..

34. Why should ODWhy should OD’’s embrace ours embrace our
new law?new law?

35. Q&A and Handout ReviewQ&A and Handout Review

36. Thank you!Thank you!