Concept

This emergency intermediate, along with it’s companion the emergency follow up, is for the purpose of checking a patient due to emergent symptoms. There are a wide variety of symptoms and conditions that can cause a patient to call in for an emergency visit some of which will be addressed below.

Workup Order

Complete visual acuity, Expedited medical history. Check the triage and discuss the symptoms with the patient and enter this as the chief complaint. If a patient is experiencing visual field loss, visual field disturbance, flashes of light, or floaters in their vision, perform an Octopus and dilate them after you check visual acuities. If it is the emergency follow up, check to see what treatment was initiated at the previous visit and ask how the patient’s symptoms have responded to the treatment.

CHARTING CHECKLIST

Layout: Emergency (Emergency f/u for the follow up)
Hx/Meds: Forward and update as needed.
Workup: Complete chief complaint according to patient’s presenting symptoms. Fill in VAs, pupils, and EOMs. Enter IOPs when completed by the doctor.
Exam: Forward anterior and posterior findings and update based on the doctors findings. As the doctor what diagnosis they would like to use as the #1 diagnosis for the appointment. Update plan to reflect all recommendations from that appointment.
Testing: Create entry for any testing done (Octopus, photos, etc)
Routing: Ask the doctor which office code they would like for the visit. Be sure to check the box for any testing done at that visit (Limited visual field, photos, etc). Indicate in the additional notes box if any follow up needs to be scheduled.

Next we will watch some videos covering four of the common reasons for an emergency visit.

pink eye

Pink Eye is a family of eye disease associated with inflammation of the conjunctiva also called “conjunctivitis”. The underlying cause of conjunctivitis can be from allergies, bacteria, or a virus and each type requires different treatment. Please watch the video below on the different types and treatments for pink eye.

Retinal Detachment

Many emergency visits are due to new flashes of light and/or floaters in the patient’s vision. Most of the time, these new symptoms are fairly benign, but they must never be dismissed because they could also indicate a retinal detachment. The three primary symptoms you will hear for retinal detachments are a shower (hundreds) of new floaters all at once, flashes of light that do not go away, and/or a curtain over a portion of their vision. Any time you encounter an emergency visit where the patient complains of new flashes of light and/or floaters, you will want to complete a screening visual field on the octopus, and also ask the doctor if they would like you to go ahead and dilate the patient (and with what % tropicamide). Please watch the following video on Retinal Detachments.

Foreign Body

Another common emergency visit is a patient presenting with a foreign body sensation in one or more eyes. Lots of different conditions can cause a foreign body sensation (such as dry eye, or allergies). However, if a patient actually has something in their eye, it will have to be removed. If the foreign body is superficial, like a hair, it can usually be removed with cotton-tip applicator. If it is embedded, like a shard of metal, it will need to be removed by either forceps, golf club spud, or needle, If the foreign body was metallic and was in the eye for several hours, it may have started to form a rust ring in the surrounding tissue, which will often have to be removed with an alger brush.

Please watch the following video that illustrates what removing a foreign body looks like.

And rust ring removal.

Two other things to note with foreign body removals. First, foreign body removal needs to have an entry made on the operative tab. Just like punctal plugs, create an entry and select the correct option from the list on the right side of the window which will auto populate the fields on the left. Just be sure to narrow down items in parentheses (such as which tool was used for the removal).

Second, a procedure code, such as foreign body removal, cannot be billed together with an office code (unless it was not the primary reason for the visit). Verify with the doctor which code under the foreign body section they would like to use, and, since these codes are easy to miss, reference the code under additional notes.

Corneal Abrasion

Please watch the following video on corneal abrasions.

A corneal abrasion may additionally be treated by something called a bandage contact lens, which is a contact lens approved for extended wear that covers the wound and assists in comfort and healing. Bandage contact lenses have their own code as seen below.

Corneal Ulcer

Please watch the following video on corneal ulcers.

Iritis

Please watch the following video on iritis.

Please take the following Checkpoint Quiz