the Routing Tab
The Routing tab is where all instructions for the eyewear stylists are recorded. These instructions include both what codes to post for billing, recommendations for contacts and glasses, where and how retinal photos should be submitted for reimbursement, any additional appointments that need to be scheduled, and clarification about dilation. Below is an example of what the Routing could look like for a normal exam; we will go through the individual components next.
Office Codes
All exams, must have both an office code and a refraction code (see example below for where these are recorded). There is only one refraction code (92015), but there are four normal exam codes you will have to memorize. These four codes are determined by two factors: insurance billed (vision vs medical) and if the patient is considered new (seen by PVC in the past 3 years) or established (not seen in the past 3 years).
92004: Vision Insurance; New Patient
92014: Vision Insurance: Established Patient
99203: Medical Insurance: New Patient
99214: Medical Insurance: Established Patient
There is an office code cheat sheet in the OA helpful things folder on the desktop which includes all exam codes for exams and intermediates if you ever need to double check which code to use (see below).
Office Code and Refraction Code highlighted.
Office Code cheat sheet in the OA helpful things folder.
The following video discusses office codes for exams.
Glasses Instructions
This box is where all of the doctor’s recommendations for an update to the patient’s glasses are recorded.
There are two components to glasses recommendations. The first component is the “level” of recommendation. This indicates to the eyewear stylist the degree to which an updated glasses prescription would benefit the patient. If the doctor thinks that there was a noticeable change from the patient’s current glasses then the doctor may say that they are “prescribing” an update to the patient’s glasses. If there wasn’t a noticeable change in prescription or improved acuity with the new prescription then the doctor may say that the update is “optional”. These levels correspond to outcomes on the EHR glasses tab on the routing flowchart which is found in the OA helpful things folder (see below). At least one outcome from the flowchart should be posted to the routing for every exam (unless the patient does not wear glasses and no glasses were recommended).
Follow the flowchart to the appropriate conclusion and post it to the glasses box in the routing.
The second component includes any additional recommendations about lens design, coatings, or material that the doctor discussed with the patient.
Such as . . .
lens type: SV (single vision distance, near, computer), PAL (no-line bifocal), LBF (lined bifocal), LTF (lined trifocal)
lens material: trivex, poly, hi-index
lens add-ons: antireflective coating, blue blocker, transitions
Lastly, include any instructions that may help the eyewear stylist establish a context in which to better assist the patient (i.e. types of frames the patient is interested in, if their current specs need adjusted, if the patient lost/damaged their most recent specs, etc).
The following video discussed how to use the glasses text box on the routing.
Contact Lens instructions
Whenever contact lenses are evaluated at an exam, initiating a process that results in a finalized cl prescription, a CL Service MUST be selected. Instructions concerning the ordering of cls and scheduling of cl related appointments should be put in the Contacts Box.
CL Services cover all cl related follow ups for the year (unless a refit into a more complex lens occurs). Because of this, the CL service level is determined by the anticipated number of follow ups that a patient will likely have. In the OA helpful things folder (subfolder cheat sheets), there is a cheat sheet that you can reference if you are uncertain which CL service to post (see below).
cl service cheat sheet
Instructions that should be recorded in the Contacts box include:
1) Any and all brands that are ok for the patient to order a year supply
2) Contact lens demos that need to be ordered for the patient to trial (and whether they are for doctor dispense, over-the-counter dispense, or shipped to the patient’s home)
3) Any contact lens checks that need to be scheduled along with the time-frame.
4) Additional CL info that may be helpful to the eyewear stylist
The following video discussed CL services and the cl service text box on the routing tab.
Retinal Photos
Retinal Photos are usually completed at exams. There are two normal categories of photos: Screening Photos and Fundus Photos.
-Screening photos are photos of the retina which are periodically updated so they can be referenced in the future if changes should occur but which, at the time of imaging, have no medical diagnosis as the basis for their capture.
-Fundus Photos are photos which have a medical diagnosis as the basis for their capture and are taken yearly to document the ongoing history of the condition. Common diagnoses for Fundus photos include any type of glaucoma diagnosis (including borderline), any type of macular degeneration diagnosis, diabetes with complications (retinopathy and/or macular edema), retinal neoplasms (freckles), high risk medications, histoplasmosis, retinal detachments, hypertensive retinopathy or retinal hemorrhaging.
After determining which type of photos are being taken, click the appropriate code box on the routing (Screening Photos: no code; Fundus Photos 92250). Next, go to the corresponding photo tab on the routing flowchart (see below), follow it to the appropriate conclusion, and paste the conclusion into the additional notes section of the routing.
Screening Photos Flowchart
Fundus Photos Flowchart. Note!!!! If a conclusion says “using diagnosis code” please replace * with the diagnosis code which is the basis for taking photos.
Please watch the following video which covers the different types of photos as well as how to use the flowcharts.
Final Notes
Lastly, put any additional notes that do not fit better in either the glasses or contacts notes boxes at the bottom of the additional notes for optician box.
These include:
1) If the patient is dilating, let the stylist know if they still need to be checked.
2) If any follow-up appointments need scheduled (except for cl checks which should be listed under cl notes)
3) Any eye health items which need to be purchased (such as dry eye masks, hypochlor, Lacripure, etc)
4) If any family members may need scheduled
The following video discussed what types of items should go in the additional notes text box on the routing tab.
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