CONCEPT
Contact lens checks (clck) serve one of two purposes. First, they are used after fitting a patient into a new contact lens (either a 1st-time fit or trial of a new brand, modality, or prescription type) to check on the patient after having worn the cls for several days to make sure that their current cls are meeting their visual/comfort/eye health/lifestyle needs before finalizing a year supply. Sometimes, a patient may have multiple clcks before a cl prescription is finalized; this is very normal and ensures the patient will be happy in their cls until they return for their next annual exam. Second, a clck can be used for a patient who has already had their prescription finalized, but, prior to their next exam, starts to experience symptoms of decrease comfort or vision in their current cls. In these cases, the doctor will check to see if the patient needs to be refit into a different material, modality, or prescription type and will likely schedule at least one more clck before finalizing the new lens.
All clcks are covered under the initial CL fit or CL service billed at the fit or exam. However, for clcks of the second type, when the patient ends up being fit into a lens of higher complexity, the doctor may upgrade the original service to a higher level. Always verify with the doctor if this upgrade is necessary.
Please watch the following video on rotation of toric cls.
and this video on RGP fit which shows what it looks like when a doctor checks the fit of an RGP lens with fluorescein dye.
WORKUP ORDER
Complete visual acuity, expedited medical history. Verify which cls the patient is wearing. Inquire how comfort and vision are with their new cls.
CHARTING CHECKLIST
Layout: CL Fit
Hx/Meds: Forward and update as needed.
Workup: Enter CLCK as the chief complaint. Fill in VAs, pupils, and EOMs.
Exam: Forward anterior and posterior findings (delete the posterior findings) and update based on the doctors findings. Forward the patient’s refractive error in the plan and make it the #1 diagnosis for the appointment. Update plan to reflect all recommendations from that appointment.
CL/Ref: Forward the last entry with whatever cls the patient is currently wearing to create a diagnositc entry titlet CLCK. Record all the doctor’s findings (fit and over-refraction) on the diagnostic entry.
If the doctor finalizes their current cls: forward the clck entry, delete all fit findings, click “make available for order”, make sure the correct doctor is listed as the prescriber, and type “ok to order” in the order notes box.
If the doctor does not finalize: create a new entry for whichever demos the doctor wants them to try next, titled demo (1,2,3,4, etc), record any fit findings, clearly indicate in the order notes box which cls the patient is to trial and when they should return for their next clck.
Routing: Check the CL check - no charge box, indicate in the contacts notes box either which cls the doctor approved to order or, if the doctor did not approve an order, which cls the patient is trialing next and when to schedule their next clck.