- Does Medicare cover punctal occlusion?
- What is the Medicare reimbursement for punctal occlusion with plugs?
- What documentation is required by Medicare?
- When can I bill an office visit on the same day as the insertion of the plugs?
- What's different about your plug (Parasol®)?
- How long has the Parasol® been on the market?
- Has the Parasol® ever been "updated"?
- How do you know what size plug to use?
- What if I bury a plug during insertion?
- How do you remove the plug if necessary?
- What is the difference between the inserters that come with the Pre-Load product as opposed to the Reusable inserters purchased for Bulk?
- How many uses will I get out of the Reusable Inserters?
- What do the different colors of the QuickLoad stand mean?
- Why use EXTEND™ vs. collagen?
- What are MicroFlow™ plugs?
- Sterilization expirations
- Can punctal occlusion be used with Restasis?
Does Medicare cover punctal occlusion?
Yes. Use 68761 (Closure of lacrimal punctum; by plug, each) to describe the professional service. The same code applies whether permanent or temporary plugs are inserted. Medicare reimbursement for the procedure includes payment for the plugs.
What is the Medicare reimbursement for punctal occlusion with plugs?
The 2010 Medicare relative value for 68761 (for temporary or permanent plug) is 3.70, which results in a 2010 national average Medicare allowed amount of $125.00 per punctum. This amount is adjusted by local indices in each area. When more than one punctum is occluded at the same time, multiple surgery rules apply. The first procedure is allowed at 100% and each additional procedure is allowed at 50%.
What documentation is required by Medicare?
Medicare and most other payers expect that a minor surgical procedure, such as 68761, will not be performed as an initial treatment for dry eyes. The chart should include documentation that other therapies were unsuccessful. Your chart documentation should clearly state that you reviewed the risks and benefits of this procedure with the patient, along with non-surgical alternatives. The chart should also confirm that you have obtained the patient's consent for the procedure.
When can I bill an office visit on the same day as the insertion of the plugs?
As is true for all minor surgical procedures (debridement, insertion of plug, removal of foreign body, etc.), no office visit is billed on the same day unless there are unusual circumstances. In most cases, the 68761 will be reported without an office visit. In some cases an office visit is reported; e.g. if the need for surgery is determined during a visit for a condition that is completely unrelated to the dry eye condition, such as a periodic evaluation for open angle glaucoma. The office visit would then be chosen based on the content of the medical record and would be reported with the 25 modifier attached. Also, it is important to report the office visit with the diagnosis code appropriate to the other diagnosis, in this example open angle glaucoma, and the 68761 in combination with the diagnosis for the dry eye condition.
What's different about your plug (Parasol®)?
The Parasol® is the #1 in punctal occluder in the dry eye market.
- Each plug is individually molded by an Odyssey team member, and we pride ourselves on the high quality of our product.
- The Parasol® has an industry-high retention rate of 92% that is backed by a 30-day pop-out guarantee.
- The Parasol® is the only plug on the market with a hollow, collapsible nose, which makes it extremely easy to insert and remove
- Simple to size (small and medium plugs will fit 95% of patients)
- The Parasol® is offered in 3 different packaging configurations, based on customer preference: Sterile Pre-Load, Bulk Non-Sterile and QuickLoad. Bulk offers lower cost per occluder whereas the pre-loaded package maximizes convenience.
How long has the Parasol® been on the market?
Has the Parasol® ever been "updated"?
In April of 2005 we "modified" the dome to make it a "lower profile" dome to lessen the chance for dome irritations. This has made the Parasol® more comfortable for patients.
How do you know what size plug to use?
With the Parasol®, the exact size is not necessary because small and medium plugs will fit approximately 95% of your patients (due to the design of the collapsible nose). We offer extra small, small, medium and large.
If the physician is new to punctal occlusion, we suggest using our .6mm Punctal Gauge/Micro Dilator. You can determine the size plug you need by using the .6mm punctal gauge as your guide.
- If the .6mm gauge goes into the punctum with a little bit of resistance but comfortably, then the medium plug is recommended.
- If the gauge will not go into the punctum without force, then the small plug is recommended.
- If the gauge goes into the punctum too easily, with excess room, the large plug is recommended.
If you are unsure, ALWAYS go DOWN in size. Due to the design of our plug, it is important not to force too large of a plug into too small of an area.
What if I bury a plug during insertion?
It is VERY difficult to bury our plug because the Cannula on the insertion instrument is designed to prevent "Migration." It is impossible to insert the cannula into the puncta—thus preventing the plug from being buried.
How do you remove the plug if necessary?
The plug should be removed carefully with a pair of forceps. Placing the tips of the forceps under the dome of the plug, slightly pull up while using a toggle (side-to-side) motion as you are pulling up. This will allow for the nose of the plug to reverse (like an umbrella in the wind), thus allowing for a safe and easy removal. Jerking the plug from the punctum without the toggle motion may create a tear in the body of the plug.
What is the difference between the inserters that come with the Pre-Load product as opposed to the Reusable inserters purchased for Bulk?
Material is the key difference. Sterile Pre-Load Inserters are designed for "One Time Use Only" and cannot be autoclaved because the instrument will melt. These instruments will have a white release button (S, M, L sizes) or a red release button (XS size).
Reusable Inserters can be Steam Autoclaved (121°–123°C) for 15 minutes. See Physician Instructions for details. These instruments have black release buttons.
How many uses will I get out of the Reusable Inserters?
These inserters have a validation of 25 autoclave cycles with careful handling as a recommendation.
What do the different colors of the QuickLoad stand mean?
We use a color-coding system on the QuickLoad configuration to denote size:
Why use EXTEND™ vs. collagen?
Collagen is short term (7-10 days) and mainly used as a diagnostic tool prior to Punctal Occlusion. EXTEND™ (Absorbable Synthetic) is longer term (90 days) and often used for pre- and post-surgical treatments such as Lasik and cataract surgery. EXTEND™ can also be used with contact lens users or temporary dry eye cases.
What are MicroFlow™ plugs?
MicroFlow™ Plugs are designed for "limited" tear flow and may be used if total occlusion is too much. The MicroFlow™ plug comes in the following sizes and configurations: Sterile Pre-Loaded- S, M, L and Bulk Non-Sterile: 5 pair/box- S, M, L.
- Sterile Pre-Load: 2 Year Expiration
- QuickLoad: 2 Year Expiration
- Lasik Eye Lid Drapes: 1 Year Expiration
- Temporary Collagen: 5 Year Expiration
- Extend Synthetic Absorbable: 5 Year Expiration
Can punctal occlusion be used with Restasis?
Yes. In, May of 2005 Odyssey completed a study by Dr. Calvin Roberts that tested both punctal occlusion and Restasis as individual treatments, as well as in combination. The study showed that using combination therapy of punctal plugs and Restasis together improved signs and symptoms of dry eye better and more quickly.